Provider Demographics
NPI:1497074819
Name:LUCAS-JENKINS, LISA (MS, LPC)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:LUCAS-JENKINS
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4030 N LINCOLN BLVD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73105-5207
Mailing Address - Country:US
Mailing Address - Phone:405-528-4673
Mailing Address - Fax:
Practice Address - Street 1:527 NW 23RD ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-1515
Practice Address - Country:US
Practice Address - Phone:405-441-5758
Practice Address - Fax:405-900-0901
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-25
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
OK6995101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health