MEDICARE: KYMBERLEY 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	MH7357	FL

General Provider Information

NPI Number	:	1295165165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYMBERLEY LUCAS

Provider Business Mailing Address
First Line	:	5 HARVARD CIR
Second Line	:	SUITE 109
City	:	WEST PALM BCH
State	:	FL
Zip	:	33409-1979
Country	:	US
Telephone Number	:	561-222-7730
Fax Number	:

Provider Business Practice Location Address
First Line	:	5 HARVARD CIR
Second Line	:	SUITE 109
City	:	WEST PALM BCH
State	:	FL
Zip	:	33409-1979
Country	:	US
Telephone Number	:	561-222-7730
Fax Number	:

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

Provider Enumeration Date	:	11/13/2013
Last Update Date	:	11/13/2013

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