Healthcare Provider Details

I. General information

NPI: 1780740340
Provider Name (Legal Business Name): KAREN KAE LUCAS L.M.H.C,L.M.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 01/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 12TH AVE STE 30
SEATTLE WA
98122-2484
US

IV. Provider business mailing address

1605 12TH AVE STE 30
SEATTLE WA
98122-2484
US

V. Phone/Fax

Practice location:
  • Phone: 206-324-5744
  • Fax:
Mailing address:
  • Phone: 206-324-5744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberRC#00044497
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00006193
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH00011339
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: