Provider Demographics
NPI:1518374669
Name:MYERS, LUCAS (LPCC)
Entity Type:Individual
Prefix:
First Name:LUCAS
Middle Name:
Last Name:MYERS
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1424 SILVER AVE SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87104-1052
Mailing Address - Country:US
Mailing Address - Phone:505-463-6653
Mailing Address - Fax:
Practice Address - Street 1:2500 CENTRAL AVE SW STE B600
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87104-1692
Practice Address - Country:US
Practice Address - Phone:505-463-6653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-21
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCCMH0198861101YM0800X
101YM0800X
NMT-0164331101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health