Healthcare Provider Details

I. General information

NPI: 1114659372
Provider Name (Legal Business Name): STEVEN THOMAS LUCAS LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2022
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 3 MILE RD NW STE G
GRAND RAPIDS MI
49544-8209
US

IV. Provider business mailing address

16460 BROWN LN
SPRING LAKE MI
49456-2116
US

V. Phone/Fax

Practice location:
  • Phone: 616-499-5762
  • Fax:
Mailing address:
  • Phone: 616-499-5762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401222460
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: