Provider Demographics
NPI:1467446989
Name:LUEBKE, CRAIG ALAN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:ALAN
Last Name:LUEBKE
Suffix:
Gender:M
Credentials:LCSW
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 100
Mailing Address - Street 2:
Mailing Address - City:ZENDA
Mailing Address - State:WI
Mailing Address - Zip Code:53195-0100
Mailing Address - Country:US
Mailing Address - Phone:262-249-0830
Mailing Address - Fax:262-249-0835
Practice Address - Street 1:160 E GENEVA SQ
Practice Address - Street 2:
Practice Address - City:LAKE GENEVA
Practice Address - State:WI
Practice Address - Zip Code:53147-9694
Practice Address - Country:US
Practice Address - Phone:262-249-0830
Practice Address - Fax:262-249-0835
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3556-1231041C0700X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
242216000OtherMAGELLAN BID HEALTH
WI39637100Medicaid
WI10671OtherDEAN CARE
2146947OtherCIGNA
WI39637100OtherCENPATICO
WI574220698004OtherBCBS
WI88416006Medicare PIN