=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841317708
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LUCY J COLVIN MFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/24/2007
-----------------------------------------------------
Last Update Date | 11/02/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1801 BUSH ST STE 221
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94109-5279
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-820-9607
-----------------------------------------------------
Fax | 415-242-7919
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 22411
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94122-0411
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-242-7919
-----------------------------------------------------
Fax | 415-665-5044
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | MFC38099
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------