Healthcare Provider Details

I. General information

NPI: 1053363648
Provider Name (Legal Business Name): MAUDIE JEAN LUCAS LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8903 KEY PENINSULA HWY N
LAKEBAY WA
98349-9326
US

IV. Provider business mailing address

PO BOX 695
LAKEBAY WA
98349-0695
US

V. Phone/Fax

Practice location:
  • Phone: 253-884-2234
  • Fax: 253-761-7979
Mailing address:
  • Phone: 253-761-5828
  • Fax: 253-761-7979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH00006545
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: