Provider Demographics
NPI:1821131624
Name:LUKEMAN, GAYLE ELLYN (LMFT, LPCC)
Entity Type:Individual
Prefix:MS
First Name:GAYLE
Middle Name:ELLYN
Last Name:LUKEMAN
Suffix:
Gender:F
Credentials:LMFT, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1763 OAK DR
Mailing Address - Street 2:
Mailing Address - City:CHINO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86323-3402
Mailing Address - Country:US
Mailing Address - Phone:530-632-3343
Mailing Address - Fax:
Practice Address - Street 1:1763 OAK DR
Practice Address - Street 2:
Practice Address - City:CHINO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86323-3402
Practice Address - Country:US
Practice Address - Phone:530-632-3343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ17877101YM0800X
CALPCC16101YM0800X
CAMFC 43536106H00000X
AZ15309106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health