Healthcare Provider Details

I. General information

NPI: 1255259917
Provider Name (Legal Business Name): LUCID LIFE THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 W WILSON BRIDGE RD STE 350
WORTHINGTON OH
43085-5220
US

IV. Provider business mailing address

164 CHESHIRE CROSSING DR
DELAWARE OH
43015-8316
US

V. Phone/Fax

Practice location:
  • Phone: 614-707-9463
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: NISRINE RINALDI
Title or Position: OWNER
Credential:
Phone: 614-707-9463