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General NPI Number Information
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NPI Number | 1588451603
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Entity Type | Individual
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Provider Name | ELIZABETH ANN LUCHT CADC
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Gender | Female
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Dates
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Enumeration Date | 04/22/2025
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Last Update Date | 05/19/2025
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Provider Practice Location Address
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Address Line | 102 N WILSON AVE
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City | JEFFERSON
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State | IA
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Zip | 50129-2116
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Country | US
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Telephone | 515-900-8661
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Fax |
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Provider Business Mailing Address
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Address Line | 115 PARK ST
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City | COON RAPIDS
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State | IA
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Zip | 50058-1322
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Country | US
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Telephone | 712-210-7104
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 20084
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License Number State | IA
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