Provider Demographics
NPI:1316373764
Name:LUCAS, STEPHANIE HANNAH (MS, LMFT, CADC-I)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:HANNAH
Last Name:LUCAS
Suffix:
Gender:F
Credentials:MS, LMFT, CADC-I
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:HANNAH
Other - Last Name:HEUSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:497 SW CENTURY DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1167
Mailing Address - Country:US
Mailing Address - Phone:541-316-8292
Mailing Address - Fax:
Practice Address - Street 1:497 SW CENTURY DR
Practice Address - Street 2:SUITE 102
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1167
Practice Address - Country:US
Practice Address - Phone:541-316-8292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-17
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORT1188OtherLMFT