Provider Demographics
NPI:1053363648
Name:LUCAS, MAUDIE JEAN (LMHC)
Entity type:Individual
Prefix:MS
First Name:MAUDIE
Middle Name:JEAN
Last Name:LUCAS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 695
Mailing Address - Street 2:
Mailing Address - City:LAKEBAY
Mailing Address - State:WA
Mailing Address - Zip Code:98349-0695
Mailing Address - Country:US
Mailing Address - Phone:253-761-5828
Mailing Address - Fax:253-761-7979
Practice Address - Street 1:8903 KEY PENINSULA HWY N
Practice Address - Street 2:
Practice Address - City:LAKEBAY
Practice Address - State:WA
Practice Address - Zip Code:98349-9326
Practice Address - Country:US
Practice Address - Phone:253-884-2234
Practice Address - Fax:253-761-7979
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00006545101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAIP278032OtherMAGELLAN
WA5795647OtherAETNA
WA9274172OtherPHCS (PRIV. HEALTHCARE SY
WA2011747OtherCIGNA
WA275030OtherVALUE OPTIONS
WA8921178OtherL&I CRIME VICTIMS
WALU6778OtherREGENCE BLUE SHIELD
WA154996OtherMHN (MANAGED HEALTH NTWK)
WAA0593OtherPREMERA BLUE CROSS