Provider Demographics
NPI:1740309137
Name:LUCAS, JOHN D (MHP 'UNDER LPC SUP')
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:D
Last Name:LUCAS
Suffix:
Gender:M
Credentials:MHP 'UNDER LPC SUP'
Other - Prefix:MR
Other - First Name:JOHN
Other - Middle Name:D
Other - Last Name:LUCAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MHP 'UNDER LPC SUP'
Mailing Address - Street 1:1432 LAKEHURST DR
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-8505
Mailing Address - Country:US
Mailing Address - Phone:580-332-6851
Mailing Address - Fax:580-310-6047
Practice Address - Street 1:931 ARLINGTON ST STE 2
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-4025
Practice Address - Country:US
Practice Address - Phone:580-332-6851
Practice Address - Fax:580-310-6047
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health