Provider Demographics
NPI:1316114887
Name:LUCAS, MATTHEW ALAN (MFT)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:ALAN
Last Name:LUCAS
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 W 7TH ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47404-3834
Mailing Address - Country:US
Mailing Address - Phone:812-339-1551
Mailing Address - Fax:812-334-8398
Practice Address - Street 1:120 W 7TH ST
Practice Address - Street 2:SUITE 104
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-3834
Practice Address - Country:US
Practice Address - Phone:812-339-1551
Practice Address - Fax:812-334-8398
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist