Provider Demographics
NPI:1326076084
Name:LUCAS, ELLEN BARBARA (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:BARBARA
Last Name:LUCAS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 444
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47308-0444
Mailing Address - Country:US
Mailing Address - Phone:765-254-9343
Mailing Address - Fax:
Practice Address - Street 1:707 W UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-3865
Practice Address - Country:US
Practice Address - Phone:765-254-9343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040571103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN20040572OtherLICENSE NUMBER