Provider Demographics
NPI:1508244880
Name:LUCAS, LINDA J (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:J
Last Name:LUCAS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 MICHIGAN AVENUE
Mailing Address - Street 2:
Mailing Address - City:OROFINO
Mailing Address - State:ID
Mailing Address - Zip Code:83544
Mailing Address - Country:US
Mailing Address - Phone:208-476-4440
Mailing Address - Fax:
Practice Address - Street 1:106 MICHIGAN AVENUE
Practice Address - Street 2:
Practice Address - City:OROFINO
Practice Address - State:ID
Practice Address - Zip Code:83544-1611
Practice Address - Country:US
Practice Address - Phone:208-476-4440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-07
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-3324101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional