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NPI Code Detail

MEDICARE: LUKE PROVCHY

MEDICARE: LUKE PROVCHY
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1558108241
Entity Type Code : Individual
Provider Name (Legal Business Name) : LUKE PROVCHY
Provider Business Mailing Address
First Line : 18860 NORDHOFF ST STE 100
Second Line :
City : NORTHRIDGE
State : CA
Zip : 91324-3879
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 18860 NORDHOFF ST STE 100
Second Line :
City : NORTHRIDGE
State : CA
Zip : 91324-3879
Country : US
Telephone Number : 818-855-1788
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/10/2024
Last Update Date : 05/19/2026

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Directions to “ LUKE PROVCHY ” Practice Location

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