Provider Demographics
NPI:1679014344
Name:LUCAS, FREDA
Entity Type:Individual
Prefix:
First Name:FREDA
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 1:6390 E 31ST ST
Mailing Address - Street 2:SUITE I
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-5478
Mailing Address - Country:US
Mailing Address - Phone:918-409-9763
Mailing Address - Fax:
Practice Address - Street 1:6390 E 31ST ST
Practice Address - Street 2:SUITE I
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-5478
Practice Address - Country:US
Practice Address - Phone:918-409-9763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-15
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator