Healthcare Provider Details

I. General information

NPI: 1326692732
Provider Name (Legal Business Name): LUCINDA L WURTZ MA LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2019
Last Update Date: 11/26/2021
Certification Date: 11/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 EAST BOONE AVENUE
SPOKANE WA
99202-9920
US

IV. Provider business mailing address

3520 N MILTON ST
SPOKANE WA
99205-2365
US

V. Phone/Fax

Practice location:
  • Phone: 509-953-1109
  • Fax:
Mailing address:
  • Phone: 509-953-1109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMG60953917
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLF61204406
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: