Healthcare Provider Details

I. General information

NPI: 1811443740
Provider Name (Legal Business Name): LETITHIA LUCAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2016
Last Update Date: 08/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2204 ST. CHARLES AVENUE SUITE 101 & 102
LECOMPTE LA
71346
US

IV. Provider business mailing address

2204 ST. CHARLES AVENUE SUITE 101 & 102
LECOMPTE LA
71346
US

V. Phone/Fax

Practice location:
  • Phone: 318-406-3044
  • Fax: 318-406-3045
Mailing address:
  • Phone: 318-406-3044
  • Fax: 318-406-3045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: