Provider Demographics
NPI:1144848953
Name:LUCAS, JESSICA LEA (MS, MT-BC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEA
Last Name:LUCAS
Suffix:
Gender:F
Credentials:MS, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 BRIMNER DR
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32327-1257
Mailing Address - Country:US
Mailing Address - Phone:850-879-2945
Mailing Address - Fax:
Practice Address - Street 1:59 BRIMNER DR
Practice Address - Street 2:
Practice Address - City:CRAWFORDVILLE
Practice Address - State:FL
Practice Address - Zip Code:32327-1257
Practice Address - Country:US
Practice Address - Phone:850-879-2945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor