Healthcare Provider Details

I. General information

NPI: 1972836963
Provider Name (Legal Business Name): LUKAS L FICKLIN LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2009
Last Update Date: 02/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N THORNTON ST STE J
CLOVIS NM
88101
US

IV. Provider business mailing address

1200 N THORNTON ST STE J
CLOVIS NM
88101-5508
US

V. Phone/Fax

Practice location:
  • Phone: 575-935-8522
  • Fax: 575-935-8524
Mailing address:
  • Phone: 575-935-8522
  • Fax: 575-935-8524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0144951
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0144951
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0144951
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: