Provider Demographics
NPI:1952079196
Name:COOK, LUCAS ANTHONY (RADT)
Entity Type:Individual
Prefix:MR
First Name:LUCAS
Middle Name:ANTHONY
Last Name:COOK
Suffix:
Gender:M
Credentials:RADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1777 BUCKMAN SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:CAMPO
Mailing Address - State:CA
Mailing Address - Zip Code:91906-2022
Mailing Address - Country:US
Mailing Address - Phone:619-478-5696
Mailing Address - Fax:
Practice Address - Street 1:1777 BUCKMAN SPRINGS RD
Practice Address - Street 2:
Practice Address - City:CAMPO
Practice Address - State:CA
Practice Address - Zip Code:91906-2022
Practice Address - Country:US
Practice Address - Phone:619-478-5696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1442880821101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)