Healthcare Provider Details

I. General information

NPI: 1588717847
Provider Name (Legal Business Name): LES C. LUCAS LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 01/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4910 E ASHLAN AVE STE 118
FRESNO CA
93726-3021
US

IV. Provider business mailing address

4910 E ASHLAN AVE STE 118
FRESNO CA
93726-3021
US

V. Phone/Fax

Practice location:
  • Phone: 559-253-4474
  • Fax: 559-348-9345
Mailing address:
  • Phone: 559-256-4474
  • Fax: 559-348-9345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number17444
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT17444
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: