Individual provider Active NPI

Charles Lucky, LLPC

  • Professional Counselor
  • Lansing, MI
National Provider Identifier
1073258869
Registry record updated May 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
6451019503 Issued in MI
Practice address
812 E Jolly Rd
Lansing, MI 48910-6818
Phone
(517) 346-8200
NPI assigned
May 5, 2022
Last updated
May 5, 2022By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 5, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 6451019503 MI Primary

Addresses

Primary practice location

812 E Jolly Rd
Lansing, MI 48910-6818

Mailing address

812 E Jolly Rd
Lansing, MI 48910-6818
Phone (517) 346-8200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260223000618 MI Practitioner - Mental Health Counselor 1355822974 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2021
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

812 E Jolly Rd
Suite 210
Lansing, MI 48910-6821

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6451019503MIMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Community Mental Health Authority Clinton Eaton Ingham Counties CurrentSince Jan 3, 2026 Accepting new patients

Locations

228 S Cochran Ave
Charlotte, MI 48813
Phone (517) 543-5100

812 E Jolly Rd
Lansing, MI 48910
Phone (517) 237-7162

812 E Jolly Rd
Ste 210
Lansing, MI 48910
Phone (517) 237-7162

812 E Jolly Rd
Ste 216
Lansing, MI 48910
Phone (517) 346-9525

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1651708800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651708800000",
    "number": "1073258869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "812 E JOLLY RD",
            "city": "LANSING",
            "state": "MI",
            "postal_code": "489106818",
            "telephone_number": "517-346-8200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "812 E JOLLY RD",
            "city": "LANSING",
            "state": "MI",
            "postal_code": "489106818",
            "telephone_number": "517-346-8200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUCKY",
        "first_name": "CHARLES",
        "credential": "LLPC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-05-05",
        "last_updated": "2022-05-05",
        "certification_date": "2022-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MI",
            "license": "6451019503",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lansing, MI

Sources for this page

Verify at the official NPI Registry.