Provider Demographics
NPI:1538887906
Name:LUCKING, HEIDI ANNE (MA, LPC-A, NCC)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:ANNE
Last Name:LUCKING
Suffix:
Gender:F
Credentials:MA, LPC-A, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29809 N MILL LN
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:WA
Mailing Address - Zip Code:99006-8398
Mailing Address - Country:US
Mailing Address - Phone:903-920-9956
Mailing Address - Fax:
Practice Address - Street 1:1131 E INTERNATIONAL AIRPORT RD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99518-1408
Practice Address - Country:US
Practice Address - Phone:907-276-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX89021101YM0800X
AK101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA202717541WAMedicaid