Provider Demographics
NPI:1477256006
Name:RUSHTON, LUCAS (LCPC-CC)
Entity Type:Individual
Prefix:
First Name:LUCAS
Middle Name:
Last Name:RUSHTON
Suffix:
Gender:M
Credentials:LCPC-CC
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 1360
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04062-1360
Mailing Address - Country:US
Mailing Address - Phone:207-893-0386
Mailing Address - Fax:207-893-2086
Practice Address - Street 1:86 TANDBERG TRL
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:ME
Practice Address - Zip Code:04062-5841
Practice Address - Country:US
Practice Address - Phone:207-893-0386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-23
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL6830101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor