Provider Demographics
NPI:1518565761
Name:LUCAS, ZECHARIAH (LPC INTERN)
Entity Type:Individual
Prefix:
First Name:ZECHARIAH
Middle Name:
Last Name:LUCAS
Suffix:
Gender:M
Credentials:LPC INTERN
Other - Prefix:
Other - First Name:ZACH
Other - Middle Name:
Other - Last Name:LUCAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1372 SE 11TH LOOP
Mailing Address - Street 2:
Mailing Address - City:CANBY
Mailing Address - State:OR
Mailing Address - Zip Code:97013-8791
Mailing Address - Country:US
Mailing Address - Phone:503-593-3405
Mailing Address - Fax:
Practice Address - Street 1:14279 S GLEN OAKS RD
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-8008
Practice Address - Country:US
Practice Address - Phone:503-732-0187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-10
Last Update Date:2020-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR5919101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health