MEDICARE: DAWN LEE 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	101YA0400X	Addiction (Substance Use Disorder) Counselor		MI

General Provider Information

NPI Number	:	1124584354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAWN LEE LUCAS

Provider Business Mailing Address
First Line	:	1480 N M 52
Second Line	:
City	:	OWOSSO
State	:	MI
Zip	:	48867-1290
Country	:	US
Telephone Number	:	989-723-8239
Fax Number	:	989-723-8230

Provider Business Practice Location Address
First Line	:	1480 N M 52
Second Line	:
City	:	OWOSSO
State	:	MI
Zip	:	48867-1290
Country	:	US
Telephone Number	:	989-723-8239
Fax Number	:	989-723-8230

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

Provider Enumeration Date	:	02/12/2019
Last Update Date	:	02/12/2019

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Directions to “ DAWN LEE LUCAS ” Practice Location

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