Healthcare Provider Details

I. General information

NPI: 1063698850
Provider Name (Legal Business Name): LINDSEY KUCICH ED.S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2008
Last Update Date: 01/10/2023
Certification Date: 01/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32582 WILDFLOWER DR
LAKE ELSINORE CA
92532-2552
US

IV. Provider business mailing address

32582 WILDFLOWER DR
LAKE ELSINORE CA
92532-2552
US

V. Phone/Fax

Practice location:
  • Phone: 702-234-0708
  • Fax:
Mailing address:
  • Phone: 702-234-0708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number220040341
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLEP3826
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: