Provider Demographics
NPI:1679285969
Name:LUCAS, GREGORY S (MED)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:S
Last Name:LUCAS
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12901 SE 97TH AVE STE 340
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-7903
Mailing Address - Country:US
Mailing Address - Phone:503-655-8045
Mailing Address - Fax:503-655-6806
Practice Address - Street 1:12901 SE 97TH AVE STE 340
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-7903
Practice Address - Country:US
Practice Address - Phone:503-655-8045
Practice Address - Fax:503-655-6806
Is Sole Proprietor?:No
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health