Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | MH 11990 | FL |
N | 103TR0400X | Rehabilitation Psychologist | 180000760 | IL |
NPI | 1053683565 |
---|---|
Provider Name | Dr. Jeff W Lucas |
First Address | Oakbrook Terrace, IL 60181-4451 |
Second Address | Oakbrook Terrace, IL 60181-4451 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2012 |
Last Update Date | 02/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
180-000760 | LICENSED CLINICAL PROFESSIONAL COUNSELOR (01) | IL |
85591931 | MEMBER AMERICAN PSYCHOLOGICAL ASSOCIATION (01) | FL |
MH 119990 | LICENSED MENTAL HEALTH COUNSELOR (01) | FL |