Provider Demographics
NPI:1578300406
Name:LUCUS, ASHLEY MICHELLE (CMT)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:MICHELLE
Last Name:LUCUS
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RYT
Mailing Address - Street 1:24242 LARKWOOD LN
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-5218
Mailing Address - Country:US
Mailing Address - Phone:949-540-8382
Mailing Address - Fax:
Practice Address - Street 1:24242 LARKWOOD LN
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-5218
Practice Address - Country:US
Practice Address - Phone:949-540-8382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA96222225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist