Active NPI
Jon Luckenbaugh
- Counselor
- Vancouver, WA
National Provider Identifier
1396101838
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- CG60517550
- Practice address
- 7415 NE 94TH Ave
Vancouver, WA 98662-3859 - Phone
- (360) 253-6019
- Fax
- (360) 253-2698
- NPI assigned
- Jan 14, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | CG60517550 | WA | Primary |
Addresses
Primary practice location
7415 NE 94TH Ave
Vancouver, WA 98662-3859
Mailing address
3921 E Fourth Plain Blvd Unit 12
Vancouver, WA 98661-5797
Phone (360) 773-2309
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CG60517550 | WA | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1452729600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1452729600000",
"number": "1396101838",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3921 E FOURTH PLAIN BLVD UNIT 12",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986615797",
"telephone_number": "360-773-2309"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7415 NE 94TH AVE",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986623859",
"telephone_number": "360-253-6019",
"fax_number": "360-253-2698"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUCKENBAUGH",
"first_name": "JON",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-01-14",
"last_updated": "2016-01-14",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "WA",
"license": "CG60517550",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vancouver, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.