Provider Demographics
NPI:1033085931
Name:LUCERO, IAN
Entity type:Individual
Prefix:
First Name:IAN
Middle Name:
Last Name:LUCERO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2585 E WILCOX DR STE A
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-2822
Mailing Address - Country:US
Mailing Address - Phone:520-442-2812
Mailing Address - Fax:520-442-2812
Practice Address - Street 1:2585 E WILCOX DR STE A
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2822
Practice Address - Country:US
Practice Address - Phone:520-442-2812
Practice Address - Fax:520-442-2812
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-16
Last Update Date:2025-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor