MEDICARE: MR. DANIEL LEWIS LUCAS M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	612192	FL
2	101YP2500X	Professional Counselor	612192	FL

General Provider Information

NPI Number	:	1497928758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DANIEL LEWIS LUCAS M.S.

Provider Business Mailing Address
First Line	:	1059 AZALEA POINTE DR
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32129-4100
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1059 AZALEA POINTE DR
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32129-4100
Country	:	US
Telephone Number	:	386-235-8299
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2008
Last Update Date	:	04/08/2008

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