1619384625 NPI number — MR. LUKE SARGENT M.A., LPCC

Table of content: MR. LUKE SARGENT M.A., LPCC (NPI 1619384625)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619384625 NPI number — MR. LUKE SARGENT M.A., LPCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SARGENT
Provider First Name:
LUKE
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.A., LPCC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619384625
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/13/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
106 STARRET ST
Provider Second Line Business Mailing Address:
SUITE 204
Provider Business Mailing Address City Name:
LANCASTER
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43130-3993
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-323-7174
Provider Business Mailing Address Fax Number:
740-477-8877

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
106 STARRET ST
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43130-3993
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-323-7174
Provider Business Practice Location Address Fax Number:
740-477-8877
Provider Enumeration Date:
07/22/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  C.1200544 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: E.1800656 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com