Provider Demographics
NPI:1245460930
Name:LUCERO, TERRI (PHD)
Entity type:Individual
Prefix:DR
First Name:TERRI
Middle Name:
Last Name:LUCERO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 53
Mailing Address - Street 2:
Mailing Address - City:EASTLAKE
Mailing Address - State:CO
Mailing Address - Zip Code:80614-0053
Mailing Address - Country:US
Mailing Address - Phone:720-377-3250
Mailing Address - Fax:720-356-0172
Practice Address - Street 1:2480 W 26TH AVE STE 10B
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-5311
Practice Address - Country:US
Practice Address - Phone:303-433-5000
Practice Address - Fax:720-356-0172
Is Sole Proprietor?:No
Enumeration Date:2009-07-16
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2402103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist