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NPI Code Detail

MEDICARE: SOPHIA LUCAS

MEDICARE: SOPHIA 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
1101YP2500XProfessional Counselor4679MN

General Provider Information

NPI Number : 1669979258
Entity Type Code : Individual
Provider Name (Legal Business Name) : SOPHIA LUCAS
Provider Business Mailing Address
First Line : 7615 GOLDEN TRIANGLE DR STE A
Second Line :
City : EDEN PRAIRIE
State : MN
Zip : 55344-3733
Country : US
Telephone Number : 612-767-7222
Fax Number :
Provider Business Practice Location Address
First Line : 7615 GOLDEN TRIANGLE DR STE A
Second Line :
City : EDEN PRAIRIE
State : MN
Zip : 55344-3733
Country : US
Telephone Number : 612-767-7222
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2018
Last Update Date : 01/14/2026

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Directions to “ SOPHIA LUCAS ” Practice Location

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