Individual
DEOTILA LUCAS TAKULYABWANI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
X
Contact information
Practice address
4570 AVERY LN SE, LACEY, WA 98503-5608
(360) 464-7935
Mailing address
26616 WEBSTER RD E, GRAHAM, WA 98338-7318
(360) 402-5946
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
61582811
WA
Other
Enumeration date
04/01/2025
Last updated
04/01/2025
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