Doctor Name: | JON LUCKENBAUGH |
NPI Number: | 1396101838 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | CG60517550 |
Business Practice Address: | 7415 Ne 94th Ave Vancouver, WA - 986623859 |
Business Phone Number: | 3602536019 |
Business Fax Number: | 3602532698 |
Mailing Address: | 3921 E Fourth Plain Blvd Unit 12, VANCOUVER |
State: | WA |
Postal Code: | 986615797 |
Phone Number: | 3607732309 |
Fax Number: | |
NPI Enumeration Date: | 01/14/2016 |
NPI Last Update Date: | 01/14/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | CG60517550 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |