Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 3801 | AZ |
NPI | 1013065325 |
---|---|
Provider Name | Dr. Wade Christian Lueck |
First Address | Mesa, AZ 85209-6687 |
Second Address | Mesa, AZ 85209-6687 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2007 |
Last Update Date | 30/10/2019 |