Provider Demographics
NPI:1265264253
Name:LUCAS, TERESA LYNN
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:LYNN
Last Name:LUCAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3515 LEFT FORK MACES CREEK RD
Mailing Address - Street 2:
Mailing Address - City:VIPER
Mailing Address - State:KY
Mailing Address - Zip Code:41774-8435
Mailing Address - Country:US
Mailing Address - Phone:606-854-4628
Mailing Address - Fax:
Practice Address - Street 1:182 ROY CAMPBELL DR
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-9407
Practice Address - Country:US
Practice Address - Phone:606-435-0888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-17
Last Update Date:2024-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator