Provider Demographics
NPI:1275990368
Name:TRAUMACARE INSTITUTE, PLLC
Entity Type:Organization
Organization Name:TRAUMACARE INSTITUTE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:SHANE
Authorized Official - Last Name:LUCK
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:480-510-6780
Mailing Address - Street 1:2638 OLD SCHOOLHOUSE ROAD
Mailing Address - Street 2:
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85901
Mailing Address - Country:US
Mailing Address - Phone:480-510-6780
Mailing Address - Fax:
Practice Address - Street 1:61 WEST CENTER STREET
Practice Address - Street 2:
Practice Address - City:SNOWFLAKE
Practice Address - State:AZ
Practice Address - Zip Code:85937
Practice Address - Country:US
Practice Address - Phone:480-510-6780
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-21
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-15864101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty