Basic Information
| Provider Information | |||||||||
| NPI: | 1588717847 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LUCAS | ||||||||
| FirstName: | LES | ||||||||
| MiddleName: | C. | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4910 E ASHLAN AVE STE 118 | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937263021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592564474 | ||||||||
| FaxNumber: | 5593489345 | ||||||||
| Practice Location | |||||||||
| Address1: | 4910 E ASHLAN AVE STE 118 | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937263021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592534474 | ||||||||
| FaxNumber: | 5593489345 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2007 | ||||||||
| LastUpdateDate: | 01/14/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 17444 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | MFT17444 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.