Provider Demographics
NPI:1346659208
Name:LUCERO, JAMES
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:LUCERO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:685 CITADEL DR E STE 345
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-5326
Mailing Address - Country:US
Mailing Address - Phone:940-368-7105
Mailing Address - Fax:
Practice Address - Street 1:1225 JENARO ST SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87121-8136
Practice Address - Country:US
Practice Address - Phone:505-331-5145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-05
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-21-52182103K00000X
373H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist