Healthcare Provider Details

I. General information

NPI: 1770645186
Provider Name (Legal Business Name): GRACE MARIE LUCIDO M.A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GRACE M LUCIDO MFT MA

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 06/25/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 SALEM ST SUITE 210
CHICO CA
95928
US

IV. Provider business mailing address

19 TERRACE DR.
CHICO CA
95926
US

V. Phone/Fax

Practice location:
  • Phone: 530-343-0626
  • Fax: 530-879-3325
Mailing address:
  • Phone: 530-343-0626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberMFC28219
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC28219
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: