Provider Demographics
NPI:1407306590
Name:FRETELUCO, LUKE MATTHEW
Entity Type:Individual
Prefix:MR
First Name:LUKE
Middle Name:MATTHEW
Last Name:FRETELUCO
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 1:2235 E FLAMINGO RD STE 402
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5197
Mailing Address - Country:US
Mailing Address - Phone:702-331-5608
Mailing Address - Fax:702-463-0996
Practice Address - Street 1:2235 E FLAMINGO RD STE 402
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5197
Practice Address - Country:US
Practice Address - Phone:702-331-5608
Practice Address - Fax:702-463-0996
Is Sole Proprietor?:No
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor