Provider Demographics
NPI:1164880217
Name:LUCAS, PATRICIA (PHD , R-DMT, LPCC)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:LUCAS
Suffix:
Gender:F
Credentials:PHD , R-DMT, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:366 PRIOR AVE N
Mailing Address - Street 2:#103
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-5165
Mailing Address - Country:US
Mailing Address - Phone:612-718-3383
Mailing Address - Fax:
Practice Address - Street 1:225 DAKOTA AVE S
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55416-1015
Practice Address - Country:US
Practice Address - Phone:612-718-3383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-03
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1761101YM0800X
MN1156101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health