Provider Demographics
NPI:1578005906
Name:LUCAS, ELISHA
Entity Type:Individual
Prefix:
First Name:ELISHA
Middle Name:
Last Name:LUCAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 SPARROW ST
Mailing Address - Street 2:
Mailing Address - City:LAKE PROVIDENCE
Mailing Address - State:LA
Mailing Address - Zip Code:71254-3035
Mailing Address - Country:US
Mailing Address - Phone:318-559-3356
Mailing Address - Fax:318-559-2044
Practice Address - Street 1:411 SPARROW ST
Practice Address - Street 2:
Practice Address - City:LAKE PROVIDENCE
Practice Address - State:LA
Practice Address - Zip Code:71254-3035
Practice Address - Country:US
Practice Address - Phone:318-559-3356
Practice Address - Fax:318-559-2044
Is Sole Proprietor?:No
Enumeration Date:2016-11-16
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health