Provider Demographics
NPI:1609955434
Name:LUECK, DAVID MICHAEL (MS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:MICHAEL
Last Name:LUECK
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7200 FRANCE AVE S
Mailing Address - Street 2:SUITE 239
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-4300
Mailing Address - Country:US
Mailing Address - Phone:952-345-1875
Mailing Address - Fax:952-345-1876
Practice Address - Street 1:7200 FRANCE AVE S
Practice Address - Street 2:SUITE 239
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4300
Practice Address - Country:US
Practice Address - Phone:952-345-1875
Practice Address - Fax:952-345-1876
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1969103TB0200X
MN533106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist