Provider Demographics
NPI:1184896680
Name:LUCKETT, BARBARA A (LCSW)
Entity type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:A
Last Name:LUCKETT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10702 LAUREN PL
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40291-4866
Mailing Address - Country:US
Mailing Address - Phone:502-585-1165
Mailing Address - Fax:502-585-1166
Practice Address - Street 1:10702 LAUREN PL
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40291-4866
Practice Address - Country:US
Practice Address - Phone:502-585-1165
Practice Address - Fax:502-585-1166
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-25
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0277225700000X
KY07941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY8200148800Medicaid
KY1427120591OtherCHANGE OF EMAIL ADDRESS FOR COMPANY - LUCKETT & CO., INC. - NPI 1427120591
KY8200148800Medicaid