Provider Demographics
NPI:1154118958
Name:LUX, BRANDON P (NCC)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:P
Last Name:LUX
Suffix:
Gender:
Credentials:NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:OLD FORGE
Mailing Address - State:PA
Mailing Address - Zip Code:18518-2107
Mailing Address - Country:US
Mailing Address - Phone:272-207-0725
Mailing Address - Fax:
Practice Address - Street 1:300 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18503-1225
Practice Address - Country:US
Practice Address - Phone:570-565-9728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAPC001193101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health