Healthcare Provider Details

I. General information

NPI: 1306662044
Provider Name (Legal Business Name): LUCY FEICKERT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2024
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2255 CHALLENGER WAY STE 107
SANTA ROSA CA
95407-5423
US

IV. Provider business mailing address

PO BOX 4574
PETALUMA CA
94955-4574
US

V. Phone/Fax

Practice location:
  • Phone: 707-565-4797
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: