Provider Demographics
NPI:1225585938
Name:LUCAS, LINDA SUSAN (MS)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:SUSAN
Last Name:LUCAS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 W CLIFTON AVE
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-5720
Mailing Address - Country:US
Mailing Address - Phone:909-730-3672
Mailing Address - Fax:
Practice Address - Street 1:1204 W CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-5720
Practice Address - Country:US
Practice Address - Phone:909-730-3672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-10
Last Update Date:2016-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT27335106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist