Healthcare Provider Details

I. General information

NPI: 1245168483
Provider Name (Legal Business Name): LUCY BAIRD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2026
Last Update Date: 05/09/2026
Certification Date: 05/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PLANTATION ISLAND DR S STE 206A
ST AUGUSTINE FL
32080-3111
US

IV. Provider business mailing address

32 SCHOONER CT
ST AUGUSTINE FL
32080-5965
US

V. Phone/Fax

Practice location:
  • Phone: 850-391-1182
  • Fax:
Mailing address:
  • Phone: 727-331-0785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH27689
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: