Healthcare Provider Details

I. General information

NPI: 1891613014
Provider Name (Legal Business Name): LUCAS ROBERT BOFF PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3616 E MAIN ST
WHITEHALL OH
43213-2913
US

IV. Provider business mailing address

7530 DUSTY PINES DR
GALENA OH
43021-9700
US

V. Phone/Fax

Practice location:
  • Phone: 888-586-7168
  • Fax:
Mailing address:
  • Phone: 419-304-8482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberLE-00064110
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: