Healthcare Provider Details

I. General information

NPI: 1821615527
Provider Name (Legal Business Name): DEBRA LUCAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2020
Last Update Date: 06/29/2020
Certification Date: 06/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1523 W LINGLEVILLE RD
STEPHENVILLE TX
76401-1821
US

IV. Provider business mailing address

1321 W RANDOL MILL RD
ARLINGTON TX
76012-3129
US

V. Phone/Fax

Practice location:
  • Phone: 855-579-5323
  • Fax: 855-579-5323
Mailing address:
  • Phone: 855-579-5323
  • Fax: 855-579-5323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: