MEDICARE: DANEIN LUCAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1104287705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANEIN LUCAS

Provider Business Mailing Address
First Line	:	3925 NW 29TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73107-1309
Country	:	US
Telephone Number	:	405-517-0633
Fax Number	:

Provider Business Practice Location Address
First Line	:	3925 NW 29TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73107-1309
Country	:	US
Telephone Number	:	405-517-0633
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2016
Last Update Date	:	03/10/2016

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Directions to “ DANEIN LUCAS ” Practice Location

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