Provider Demographics
NPI:1467105577
Name:KING, LUCAS CHRISTOPHER (MSW, LCSW)
Entity Type:Individual
Prefix:MR
First Name:LUCAS
Middle Name:CHRISTOPHER
Last Name:KING
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2526 NW TYLER AVE
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-5409
Mailing Address - Country:US
Mailing Address - Phone:541-250-2761
Mailing Address - Fax:
Practice Address - Street 1:2526 NW TYLER AVE
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-5409
Practice Address - Country:US
Practice Address - Phone:541-250-2761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-28
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL44251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical