Provider Demographics
NPI:1205433059
Name:LUCERO, STEVEN (PHD, MBA)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:
Last Name:LUCERO
Suffix:
Gender:M
Credentials:PHD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 S 1250 E
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-6770
Mailing Address - Country:US
Mailing Address - Phone:307-631-0148
Mailing Address - Fax:
Practice Address - Street 1:93 S 1250 E
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-6770
Practice Address - Country:US
Practice Address - Phone:307-631-0148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8728523-2501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical