Individual
MATTHEW EDWARD LUCKENBACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
8150 WORNALL RD, KANSAS CITY, MO 64114-5806
(816) 682-1596
Mailing address
949 NE COLUMBUS ST, LEES SUMMIT, MO 64086-2977
(816) 682-1596
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
2011024810
MO
Other
Enumeration date
05/22/2012
Last updated
01/31/2014
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