Healthcare Provider Details

I. General information

NPI: 1487142857
Provider Name (Legal Business Name): LUCAS AARON BENNETT MA, LICDC, IMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2018
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 BOARDMAN CANFIELD RD
YOUNGSTOWN OH
44512-4380
US

IV. Provider business mailing address

412 N ELM ST
COLUMBIANA OH
44408-1025
US

V. Phone/Fax

Practice location:
  • Phone: 330-330-8655
  • Fax: 330-330-8657
Mailing address:
  • Phone: 330-429-3670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA165216
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLICDC.161820
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.1800799-TRNE
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberM.2100176
License Number StateOH
# 5
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberF.2500544
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: