MEDICARE: DAVETTA CLUKE LPC

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	101YP2500X	Professional Counselor	93567	TX
2	101YM0800X	Mental Health Counselor	93567	TX
3	101Y00000X	Counselor	93567	TX

General Provider Information

NPI Number	:	1285282921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVETTA CLUKE LPC

Provider Business Mailing Address
First Line	:	539 W COMMERCE ST STE 4013
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75208-1953
Country	:	US
Telephone Number	:	469-559-8106
Fax Number	:

Provider Business Practice Location Address
First Line	:	539 W COMMERCE ST STE 4013
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75208-1953
Country	:	US
Telephone Number	:	469-551-3744
Fax Number	:

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

Provider Enumeration Date	:	08/27/2019
Last Update Date	:	06/20/2026

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