Individual
CHARRYSE FOUQUETTE LUCKEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D, BCBA-D
Contact information
Practice address
1830 27TH ST SE UNIT E, SAINT CLOUD, MN 56304-8601
(651) 503-7696
Mailing address
1830 27TH ST SE UNIT E, SAINT CLOUD, MN 56304-8601
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
1-05-2231
MN
103TC0700X
Clinical Psychologist
Primary
6660
MN
Other
Enumeration date
06/10/2018
Last updated
10/26/2022
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