MEDICARE: LUCID BEHAVIORAL HEALTH PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1063244275
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUCID BEHAVIORAL HEALTH PC

Provider Business Mailing Address
First Line	:	2556 AMETHYST DR
Second Line	:
City	:	SANTA CLARA
State	:	CA
Zip	:	95051-1155
Country	:	US
Telephone Number	:	734-730-4218
Fax Number	:

Provider Business Practice Location Address
First Line	:	2556 AMETHYST DR
Second Line	:
City	:	SANTA CLARA
State	:	CA
Zip	:	95051-1155
Country	:	US
Telephone Number	:	734-730-4218
Fax Number	:

Authorized Official
Title or Position	:	MD
Name	:	TORAL DESAI
Credential	:
Telephone Number	:	734-730-4218

Provider Enumeration Date	:	08/16/2024
Last Update Date	:	08/16/2024

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