Provider Demographics
NPI:1235335548
Name:EADS, LUCILLE J (MS RN CS CMFT)
Entity Type:Individual
Prefix:MRS
First Name:LUCILLE
Middle Name:J
Last Name:EADS
Suffix:
Gender:F
Credentials:MS RN CS CMFT
Other - Prefix:MRS
Other - First Name:LUCY
Other - Middle Name:ZJ
Other - Last Name:EADS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSRNCSCMFT
Mailing Address - Street 1:3010 N 68TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-6804
Mailing Address - Country:US
Mailing Address - Phone:480-945-5987
Mailing Address - Fax:
Practice Address - Street 1:3010 N 68TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6804
Practice Address - Country:US
Practice Address - Phone:480-945-5987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMFT-0011106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist