Provider Demographics
NPI:1154626539
Name:STREETS, LUCAS EMIL
Entity Type:Individual
Prefix:MR
First Name:LUCAS
Middle Name:EMIL
Last Name:STREETS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8116 NW 29TH ST
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:OK
Mailing Address - Zip Code:73008-4321
Mailing Address - Country:US
Mailing Address - Phone:405-596-5244
Mailing Address - Fax:
Practice Address - Street 1:8116 NW 29TH ST
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:OK
Practice Address - Zip Code:73008-4321
Practice Address - Country:US
Practice Address - Phone:405-596-5244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-17
Last Update Date:2011-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health