Provider Demographics
NPI:1326692732
Name:WURTZ, LUCINDA L (MA LMFT)
Entity Type:Individual
Prefix:
First Name:LUCINDA
Middle Name:L
Last Name:WURTZ
Suffix:
Gender:F
Credentials:MA LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3520 N MILTON ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-2365
Mailing Address - Country:US
Mailing Address - Phone:509-953-1109
Mailing Address - Fax:
Practice Address - Street 1:3101 EAST BOONE AVENUE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-9920
Practice Address - Country:US
Practice Address - Phone:509-953-1109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-25
Last Update Date:2021-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG60953917106H00000X
WALF61204406106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist