Healthcare Provider Details

I. General information

NPI: 1598523987
Provider Name (Legal Business Name): BRANDY LUCAS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2024
Last Update Date: 03/11/2024
Certification Date: 03/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3513 JOURNEY WAY
CLOVIS CA
93619-8036
US

IV. Provider business mailing address

3513 JOURNEY WAY
CLOVIS CA
93619-8036
US

V. Phone/Fax

Practice location:
  • Phone: 559-284-8452
  • Fax:
Mailing address:
  • Phone: 559-284-8452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLF60258219
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: