Healthcare Provider Details

I. General information

NPI: 1245228493
Provider Name (Legal Business Name): STEVEN D LUZADER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 04/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 E INDIANA ST STE 103
EVANSVILLE IN
47715-2794
US

IV. Provider business mailing address

7300 E INDIANA ST STE 103
EVANSVILLE IN
47715-2794
US

V. Phone/Fax

Practice location:
  • Phone: 812-401-8008
  • Fax: 812-404-8201
Mailing address:
  • Phone: 812-401-8008
  • Fax: 812-404-8201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34000148A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number34000148A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: