Provider Demographics
NPI:1750261319
Name:LUCKEY BOTHE, NAOMI ANN
Entity type:Individual
Prefix:
First Name:NAOMI
Middle Name:ANN
Last Name:LUCKEY BOTHE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 S MILL ST
Mailing Address - Street 2:
Mailing Address - City:DECORAH
Mailing Address - State:IA
Mailing Address - Zip Code:52101-2029
Mailing Address - Country:US
Mailing Address - Phone:563-380-2353
Mailing Address - Fax:
Practice Address - Street 1:602 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:FAYETTE
Practice Address - State:IA
Practice Address - Zip Code:52142-9206
Practice Address - Country:US
Practice Address - Phone:800-553-4150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-04
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor