MEDICARE: ASHLEY 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	LF61066413	WA
2	172V00000X	Community Health Worker		NV
3	106H00000X	Marriage & Family Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LF61066413	OTHER	WA	MARRIAGE AND FAMILY THERAPIST LICENSE

General Provider Information

NPI Number	:	1598148785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY LUCAS

Provider Business Mailing Address
First Line	:	6688 NE BAYVIEW BLVD
Second Line	:
City	:	BAINBRIDGE ISLAND
State	:	WA
Zip	:	98110-1283
Country	:	US
Telephone Number	:	620-481-6768
Fax Number	:

Provider Business Practice Location Address
First Line	:	3285 CASEY DR
Second Line	:	AP 102
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-1367
Country	:	US
Telephone Number	:	620-481-6768
Fax Number	:

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

Provider Enumeration Date	:	07/07/2015
Last Update Date	:	03/19/2021

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Directions to “ ASHLEY LUCAS ” Practice Location

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