Provider Demographics
NPI:1841421328
Name:LUCKS PSYCHOLOGY, INC
Entity Type:Organization
Organization Name:LUCKS PSYCHOLOGY, INC
Other - Org Name:BONNIE LUCKS, PH.D
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:DOREEN
Authorized Official - Last Name:LUCKS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:619-569-0777
Mailing Address - Street 1:PO BOX 191274
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92159-1274
Mailing Address - Country:US
Mailing Address - Phone:619-569-0777
Mailing Address - Fax:619-644-5518
Practice Address - Street 1:6367 ALVARADO CT STE 200
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-4915
Practice Address - Country:US
Practice Address - Phone:619-569-0777
Practice Address - Fax:619-563-4559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-03
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22788103T00000X, 103TC0700X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB617AMedicare UPIN