Provider Demographics
NPI:1316555170
Name:LUECK, BRIAN (MA)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:LUECK
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 HUNTER PARK
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-2532
Mailing Address - Country:US
Mailing Address - Phone:304-487-6121
Mailing Address - Fax:304-487-8741
Practice Address - Street 1:211 HUNTER PARK
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2532
Practice Address - Country:US
Practice Address - Phone:304-487-6121
Practice Address - Fax:304-487-8741
Is Sole Proprietor?:No
Enumeration Date:2020-07-17
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1255103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist