MEDICARE: MS. MARJORIE LUCAS LMFT

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	106H00000X	Marriage & Family Therapist	MG20581	CA

General Provider Information

NPI Number	:	1336160894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARJORIE LUCAS LMFT

Provider Business Mailing Address
First Line	:	14804 REEDLEY ST
Second Line	:	#A
City	:	MOORPARK
State	:	CA
Zip	:	93021-2537
Country	:	US
Telephone Number	:	805-523-2192
Fax Number	:

Provider Business Practice Location Address
First Line	:	4165 E THOUSAND OAKS BLVD
Second Line	:	#345
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91362-3814
Country	:	US
Telephone Number	:	805-807-9021
Fax Number	:

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

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	07/08/2007

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