Healthcare Provider Details

I. General information

NPI: 1730093071
Provider Name (Legal Business Name): VICTORIA LUKEHART
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42101 GRISWOLD RD
ELYRIA OH
44035-2117
US

IV. Provider business mailing address

6908 MURRAY RIDGE RD
ELYRIA OH
44035-2047
US

V. Phone/Fax

Practice location:
  • Phone: 440-284-8041
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberLSP.03076
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: