Provider Demographics
NPI:1629500723
Name:LUEBCKE, BRENT ANTHONY (PHD, HSPP)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:ANTHONY
Last Name:LUEBCKE
Suffix:
Gender:M
Credentials:PHD, HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 N MERIDIAN ST STE 819
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46204-1719
Mailing Address - Country:US
Mailing Address - Phone:317-418-0974
Mailing Address - Fax:
Practice Address - Street 1:320 N MERIDIAN ST STE 819
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46204-1719
Practice Address - Country:US
Practice Address - Phone:765-418-0974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-29
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20043699A103TC1900X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty