Healthcare Provider Details

I. General information

NPI: 1396039392
Provider Name (Legal Business Name): HEATHER LUCAS LLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2011
Last Update Date: 06/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31500 SCHOOLCRAFT RD SUITE 100
LIVONIA MI
48150-1805
US

IV. Provider business mailing address

12850 FOUNTAIN SQ SUITE 106
DAVISBURG MI
48350-2552
US

V. Phone/Fax

Practice location:
  • Phone: 734-422-9340
  • Fax: 734-422-9353
Mailing address:
  • Phone: 248-634-6303
  • Fax: 248-634-1746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301014385
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: