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General NPI Number Information
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NPI Number | 1144580648
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Entity Type | Individual
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Provider Name | LUCAS JAY HOOKER MS
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Gender | Male
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Dates
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Enumeration Date | 05/18/2012
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Last Update Date | 07/16/2023
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Provider Practice Location Address
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Address Line | 136 S ACADEMY AVE
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City | EAGLE
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State | ID
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Zip | 83616-6541
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Country | US
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Telephone | 208-861-3411
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Fax |
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Provider Business Mailing Address
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Address Line | 6275 N HEATHROW CT
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City | BOISE
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State | ID
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Zip | 83713-0970
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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