Provider Demographics
NPI:1396436846
Name:PETTENGILL, LUCAS CHRISTOPHER (LMFTA)
Entity type:Individual
Prefix:
First Name:LUCAS
Middle Name:CHRISTOPHER
Last Name:PETTENGILL
Suffix:
Gender:M
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 LAZY CREEK LN
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-7809
Mailing Address - Country:US
Mailing Address - Phone:760-331-4066
Mailing Address - Fax:
Practice Address - Street 1:20 LAZY CREEK LN
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-7809
Practice Address - Country:US
Practice Address - Phone:760-331-4066
Practice Address - Fax:760-331-4966
Is Sole Proprietor?:No
Enumeration Date:2023-05-16
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
WA106H00000X
WAMG61562823106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No104100000XBehavioral Health & Social Service ProvidersSocial Worker