Provider Demographics
NPI:1528730736
Name:THOMPSON, LUCAS T (BA)
Entity type:Individual
Prefix:
First Name:LUCAS
Middle Name:T
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3096 MODOC RD
Mailing Address - Street 2:
Mailing Address - City:BURKESVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42717-8879
Mailing Address - Country:US
Mailing Address - Phone:704-591-3352
Mailing Address - Fax:
Practice Address - Street 1:3096 MODOC RD
Practice Address - Street 2:
Practice Address - City:BURKESVILLE
Practice Address - State:KY
Practice Address - Zip Code:42717-8879
Practice Address - Country:US
Practice Address - Phone:704-591-3352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-05
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator