Provider Demographics
NPI:1083585467
Name:LUCAS, MIKALA SUZANNE
Entity type:Individual
Prefix:
First Name:MIKALA
Middle Name:SUZANNE
Last Name:LUCAS
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5915 S EMERSON AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-1972
Mailing Address - Country:US
Mailing Address - Phone:317-759-3240
Mailing Address - Fax:
Practice Address - Street 1:5915 S EMERSON AVE STE 100
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-1972
Practice Address - Country:US
Practice Address - Phone:317-759-3240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-17
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician