Provider Demographics
NPI:1972836963
Name:FICKLIN, LUKAS L (LPCC)
Entity Type:Individual
Prefix:MR
First Name:LUKAS
Middle Name:L
Last Name:FICKLIN
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 N THORNTON ST
Mailing Address - Street 2:STE J
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-5508
Mailing Address - Country:US
Mailing Address - Phone:575-935-8522
Mailing Address - Fax:575-935-8524
Practice Address - Street 1:1200 N THORNTON ST STE J
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101
Practice Address - Country:US
Practice Address - Phone:575-935-8522
Practice Address - Fax:575-935-8524
Is Sole Proprietor?:No
Enumeration Date:2009-09-09
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0144951101YP2500X, 101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM357783771Medicaid