Provider Demographics
NPI:1265853352
Name:LUX, THERESA (MSC)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:
Last Name:LUX
Suffix:
Gender:F
Credentials:MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 ANSELM DR
Mailing Address - Street 2:
Mailing Address - City:RICHBORO
Mailing Address - State:PA
Mailing Address - Zip Code:18954-2031
Mailing Address - Country:US
Mailing Address - Phone:215-953-8265
Mailing Address - Fax:
Practice Address - Street 1:638 NEWTOWN YARDLEY RD
Practice Address - Street 2:SUITE 1F
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-1758
Practice Address - Country:US
Practice Address - Phone:215-579-0670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-17
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH000831103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst