Provider Demographics
NPI:1700767712
Name:LUCKY UNKNOWN LLC
Entity type:Organization
Organization Name:LUCKY UNKNOWN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MALIK
Authorized Official - Middle Name:
Authorized Official - Last Name:STUCKEY
Authorized Official - Suffix:
Authorized Official - Credentials:MLS, BCBA, LBA
Authorized Official - Phone:808-500-3649
Mailing Address - Street 1:11174 W GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-7923
Mailing Address - Country:US
Mailing Address - Phone:808-500-3649
Mailing Address - Fax:
Practice Address - Street 1:11174 W GARFIELD ST
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-7923
Practice Address - Country:US
Practice Address - Phone:808-500-3649
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-08
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty