Active NPI
Lucas Allan Broten, PH.D., LP
- Psychologist
- Reno, NV
National Provider Identifier
1407101835
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PYT150330
- Practice address
- 1055 S Wells Ave
Reno, NV 89502-2550 - Phone
- (775) 329-6300
- Fax
- (775) 348-3896
- NPI assigned
- Jul 23, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 9716 | NE | |
| Psychologist | 103T00000X | 861 | NE | |
| Psychologist | 103T00000X | PYT150330 | NV | Primary |
Addresses
Primary practice location
1055 S Wells Ave
Reno, NV 89502-2550
Mailing address
680 S Rock Blvd
Reno, NV 89502-4113
Phone (775) 329-6300
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100261397-00 | Medicaid | NE | |
| 470376606-24 | Medicaid | NE | |
| 10026251000 | Medicaid | NE | |
| 470376606-31 | Medicaid | NE |
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 |
|---|---|---|---|
| 861 | NE | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1343001600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1443657600000",
"number": "1407101835",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "680 S ROCK BLVD",
"city": "RENO",
"state": "NV",
"postal_code": "895024113",
"telephone_number": "775-329-6300",
"fax_number": "775-348-3896"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1055 S WELLS AVE",
"city": "RENO",
"state": "NV",
"postal_code": "895022550",
"telephone_number": "775-329-6300",
"fax_number": "775-348-3896"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROTEN",
"first_name": "LUCAS",
"middle_name": "ALLAN",
"credential": "PH.D., LP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-07-23",
"last_updated": "2015-10-01",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "NE",
"license": "9716",
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NE",
"license": "861",
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NV",
"license": "PYT150330",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100261397-00",
"state": "NE"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "470376606-24",
"state": "NE"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "10026251000",
"state": "NE"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "470376606-31",
"state": "NE"
}
],
"endpoints": [],
"other_names": []
}Other providers in Reno, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.