Provider Demographics
NPI:1487142857
Name:BENNETT, LUCAS AARON (MA, LICDC, MFT)
Entity type:Individual
Prefix:MR
First Name:LUCAS
Middle Name:AARON
Last Name:BENNETT
Suffix:
Gender:M
Credentials:MA, LICDC, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30697 KING RD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OH
Mailing Address - Zip Code:44460-9531
Mailing Address - Country:US
Mailing Address - Phone:330-429-3670
Mailing Address - Fax:740-314-5527
Practice Address - Street 1:320 MARKET ST
Practice Address - Street 2:
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-2153
Practice Address - Country:US
Practice Address - Phone:740-314-5339
Practice Address - Fax:740-314-5527
Is Sole Proprietor?:No
Enumeration Date:2018-05-01
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA165216101YA0400X
OHC.1800799-TRNE101YM0800X
OHM.2100176106H00000X
OHLICDC.161820101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist