Healthcare Provider Details

I. General information

NPI: 1023604410
Provider Name (Legal Business Name): LUCID SYNCHRONICITY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2020
Last Update Date: 12/19/2020
Certification Date: 12/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 E 16TH ST # 205
VANCOUVER WA
98663-3410
US

IV. Provider business mailing address

303 E 16TH ST # 205
VANCOUVER WA
98663-3410
US

V. Phone/Fax

Practice location:
  • Phone: 971-258-2965
  • 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
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: SARAH A COOMBS
Title or Position: PSYCHOTHERAPIST
Credential: LMHC, LPC, NCC
Phone: 971-258-2965