Provider Demographics
NPI:1629052865
Name:HARRIS-LUKEN, MARTHA (MS LSW CCDC111)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:
Last Name:HARRIS-LUKEN
Suffix:
Gender:F
Credentials:MS LSW CCDC111
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 WOODMAN DR.
Mailing Address - Street 2:STE 100
Mailing Address - City:DAYTEN
Mailing Address - State:OH
Mailing Address - Zip Code:45432
Mailing Address - Country:US
Mailing Address - Phone:937-424-8816
Mailing Address - Fax:937-424-8656
Practice Address - Street 1:1320 WOODMAN DR.
Practice Address - Street 2:STE 100
Practice Address - City:DAYTEN
Practice Address - State:OH
Practice Address - Zip Code:45432
Practice Address - Country:US
Practice Address - Phone:937-424-8816
Practice Address - Fax:937-424-8656
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH976195101YA0400X
OHS0015182104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHAT9354581Medicare ID - Type Unspecified