Provider Demographics
NPI:1760705149
Name:LUCAS, EDDIE RICHARD
Entity Type:Individual
Prefix:MR
First Name:EDDIE
Middle Name:RICHARD
Last Name:LUCAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1065 E. MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93001
Mailing Address - Country:US
Mailing Address - Phone:805-652-0599
Mailing Address - Fax:805-652-0608
Practice Address - Street 1:1065 E. MAIN STREET
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93001
Practice Address - Country:US
Practice Address - Phone:805-652-0599
Practice Address - Fax:805-652-0608
Is Sole Proprietor?:No
Enumeration Date:2010-03-12
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health