Healthcare Provider Details

I. General information

NPI: 1730103375
Provider Name (Legal Business Name): JOHN J LURKINS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 09/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 ESKENAZI AVE
INDIANAPOLIS IN
46202-5187
US

IV. Provider business mailing address

720 ESKENAZI AVE
INDIANAPOLIS IN
46202-5187
US

V. Phone/Fax

Practice location:
  • Phone: 317-880-7666
  • Fax: 317-880-0448
Mailing address:
  • Phone: 317-554-2704
  • Fax: 317-554-2721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2004024418
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number50540
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34007176A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: