Provider Demographics
NPI:1891547485
Name:LUKACS, MIA KAY
Entity Type:Individual
Prefix:
First Name:MIA
Middle Name:KAY
Last Name:LUKACS
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:NOA
Other - Middle Name:KAY
Other - Last Name:LUKACS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9490 VINECREST RD
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CA
Mailing Address - Zip Code:95492-9163
Mailing Address - Country:US
Mailing Address - Phone:707-217-3880
Mailing Address - Fax:
Practice Address - Street 1:9490 VINECREST RD
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CA
Practice Address - Zip Code:95492-9163
Practice Address - Country:US
Practice Address - Phone:707-217-3880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-05
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician