Provider Demographics
NPI:1740403476
Name:DR. MARTIE RYAN LUKANICH
Entity Type:Organization
Organization Name:DR. MARTIE RYAN LUKANICH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSIONAL COUNSELOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIE
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:LUKANICH
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD,LCPC
Authorized Official - Phone:708-829-8277
Mailing Address - Street 1:9601 165TH ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-5660
Mailing Address - Country:US
Mailing Address - Phone:708-829-8277
Mailing Address - Fax:708-352-2305
Practice Address - Street 1:9601 165TH ST
Practice Address - Street 2:SUITE 6
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-5660
Practice Address - Country:US
Practice Address - Phone:708-829-8277
Practice Address - Fax:708-352-2305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty