Provider Demographics
NPI:1821349812
Name:BREWER, LUCAS (LPCC-S)
Entity Type:Individual
Prefix:
First Name:LUCAS
Middle Name:
Last Name:BREWER
Suffix:
Gender:M
Credentials:LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1524 E STROOP RD STE 300
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-5059
Mailing Address - Country:US
Mailing Address - Phone:937-825-3223
Mailing Address - Fax:513-751-0180
Practice Address - Street 1:1524 E STROOP RD STE 300
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429
Practice Address - Country:US
Practice Address - Phone:937-825-3223
Practice Address - Fax:513-751-0180
Is Sole Proprietor?:No
Enumeration Date:2012-10-01
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC .1000029101YP2500X
OHE.1400023-SUPV101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH180459Medicaid