Provider Demographics
NPI:1760541684
Name:LUCKE, HERMAN H (PH D)
Entity Type:Individual
Prefix:DR
First Name:HERMAN
Middle Name:H
Last Name:LUCKE
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7280 NW 87TH TER STE 210
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64153-3706
Mailing Address - Country:US
Mailing Address - Phone:816-587-2626
Mailing Address - Fax:816-587-2627
Practice Address - Street 1:7280 NW 87TH TER
Practice Address - Street 2:SUITE 210
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64153-3720
Practice Address - Country:US
Practice Address - Phone:816-587-2626
Practice Address - Fax:816-587-2627
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2014-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPY01499103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO493269609Medicaid
MO18054018OtherBCBS MISSOURI
KS701737OtherBCBS KANSAS
MO493269609Medicaid