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General NPI Number Information
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NPI Number | 1073742961
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Entity Type | Organization
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Legal Business Name | MICHAEL DAVID LUKENS, PHD., PA
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Dates
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Enumeration Date | 07/13/2009
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Last Update Date | 12/17/2009
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Provider Practice Location Address
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Address Line | 169 TEQUESTA DR SUITE 23E
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City | TEQUESTA
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State | FL
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Zip | 33469-2768
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Country | US
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Telephone | 561-744-1169
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Fax |
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Provider Business Mailing Address
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Address Line | 169 TEQUESTA DR SUITE 23E
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City | TEQUESTA
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State | FL
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Zip | 33469-2768
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Country | US
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Telephone | 561-744-1169
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL DAVID LUKENS
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Credential | PH.D
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Telephone | 561-744-1169
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY4410
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License Number State | FL
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