Healthcare Provider Details

I. General information

NPI: 1063071124
Provider Name (Legal Business Name): LUCAS MERRILL LEEK MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: LISA MARIE LEEK

II. Dates (important events)

Enumeration Date: 06/11/2019
Last Update Date: 04/07/2020
Certification Date: 04/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 E INDIANA AVE
SPOKANE WA
99207-2313
US

IV. Provider business mailing address

1417 S LINCOLN ST
SPOKANE WA
99203-1049
US

V. Phone/Fax

Practice location:
  • Phone: 866-904-7721
  • Fax:
Mailing address:
  • Phone: 509-822-9351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSC60975670
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: