Provider Demographics
NPI:1154455368
Name:LUCAS, SANDRA RENE (MA)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:RENE
Last Name:LUCAS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1799
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-1799
Mailing Address - Country:US
Mailing Address - Phone:503-472-4020
Mailing Address - Fax:503-200-1416
Practice Address - Street 1:410 NE 3RD ST STE 2
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128
Practice Address - Country:US
Practice Address - Phone:503-472-4020
Practice Address - Fax:503-200-1416
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist