Active NPI
Charryse Fouquette Luckey, PH.D, BCBA-D
- Clinical Psychologist
- Saint Cloud, MN
National Provider Identifier
1073006524
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 6660
- Practice address
- 1830 27TH St SE Unit E
Saint Cloud, MN 56304-8601 - Phone
- (651) 503-7696
- NPI assigned
- Jun 10, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 1-05-2231 | MN | |
| Clinical Psychologist | 103TC0700X | 6660 | MN | Primary |
Addresses
Primary practice location
1830 27TH St SE Unit E
Saint Cloud, MN 56304-8601
Mailing address
1830 27TH St SE Unit E
Saint Cloud, MN 56304-8601
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6660 | MN | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lovaas Institute for Early Intervention - Midwest, Inc. | Behavior Analyst | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Behavioral Health Agency
- Bloomington, MN
- NPI 1487732764
Behavior Analyst
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1528588800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1666742400000",
"number": "1073006524",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1830 27TH ST SE UNIT E",
"city": "SAINT CLOUD",
"state": "MN",
"postal_code": "563048601"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1830 27TH ST SE UNIT E",
"city": "SAINT CLOUD",
"state": "MN",
"postal_code": "563048601",
"telephone_number": "651-503-7696"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUCKEY",
"first_name": "CHARRYSE",
"middle_name": "FOUQUETTE",
"credential": "PH.D, BCBA-D",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-06-10",
"last_updated": "2022-10-26",
"certification_date": "2022-10-26",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "MN",
"license": "1-05-2231",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MN",
"license": "6660",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Cloud, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.