Provider Demographics
NPI:1508631292
Name:LUCKHOO, GAJENDRANATH (LMHC)
Entity Type:Individual
Prefix:
First Name:GAJENDRANATH
Middle Name:
Last Name:LUCKHOO
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:GAVIN
Other - Middle Name:
Other - Last Name:LUCKHOO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:13329 SUNSET SAPPHIRE CT
Mailing Address - Street 2:
Mailing Address - City:PARRISH
Mailing Address - State:FL
Mailing Address - Zip Code:34219-2495
Mailing Address - Country:US
Mailing Address - Phone:954-245-9382
Mailing Address - Fax:
Practice Address - Street 1:13329 SUNSET SAPPHIRE CT
Practice Address - Street 2:
Practice Address - City:PARRISH
Practice Address - State:FL
Practice Address - Zip Code:34219-2495
Practice Address - Country:US
Practice Address - Phone:954-245-9382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-22
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH21305101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health