Healthcare Provider Details

I. General information

NPI: 1154118958
Provider Name (Legal Business Name): BRANDON P LUX NCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2025
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MULBERRY ST
SCRANTON PA
18503-1225
US

IV. Provider business mailing address

324 RIVER ST
OLD FORGE PA
18518-2107
US

V. Phone/Fax

Practice location:
  • Phone: 570-565-9728
  • Fax:
Mailing address:
  • Phone: 272-207-0725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPC001193
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: