Healthcare Provider Details

I. General information

NPI: 1689555773
Provider Name (Legal Business Name): LUCENTIA, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2025
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2203 E UNION ST APT 106
SEATTLE WA
98122-3475
US

IV. Provider business mailing address

102 JENNY LN
MONTGOMERY TX
77356-4416
US

V. Phone/Fax

Practice location:
  • Phone: 936-446-7661
  • Fax:
Mailing address:
  • Phone: 936-446-7661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name: BROOKE MONET ANTHONY
Title or Position: DR.
Credential: ND
Phone: 936-446-7661