Provider Information for 1114659372
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Mr. STEVEN THOMAS LUCAS LPC
Sex: Male
NPI: 1114659372
Last Updated: 2025-01-15
Certification Date: 2025-01-15
Certification Date: 2025-01-15
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1114659372 | ||||||||
| Enumeration Date | 2022-06-27 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 16460 BROWN LN SPRING LAKE, MI 49456-2116 United States Phone: 616-499-5762 | Fax: | ||||||||
| Primary Practice Address | 640 3 MILE RD NW STE G GRAND RAPIDS, MI 49544-8209 United States Phone: 616-499-5762 | Fax: | ||||||||
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