Basic Information
| Provider Information | |||||||||
| NPI: | 1578944963 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | LUCAS | ||||||||
| MiddleName: | STEVEN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 196 | ||||||||
| Address2: | |||||||||
| City: | SPANAWAY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983870196 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2532563196 | ||||||||
| FaxNumber: | 2535444080 | ||||||||
| Practice Location | |||||||||
| Address1: | 522 W RIVERSIDE AVE STE N | ||||||||
| Address2: | |||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992010580 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2532563196 | ||||||||
| FaxNumber: | 2535444080 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2015 | ||||||||
| LastUpdateDate: | 01/24/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LW60916054 | WA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.