Healthcare Provider Details

I. General information

NPI: 1093624256
Provider Name (Legal Business Name): STEPHEN LUKINS
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

626 MARSHALL ST
LANSING MI
48912-1598
US

IV. Provider business mailing address

626 MARSHALL ST
LANSING MI
48912-1598
US

V. Phone/Fax

Practice location:
  • Phone: 517-755-1058
  • Fax: 515-755-1059
Mailing address:
  • Phone: 517-755-1058
  • Fax: 515-755-1059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberCC-0C3630279446
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: