Provider Demographics
NPI:1477047595
Name:LUCID LANE INC
Entity Type:Organization
Organization Name:LUCID LANE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF RCM AND COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:MUBEENA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDDIQUI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-589-2730
Mailing Address - Street 1:221 MAIN ST # 148
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-2937
Mailing Address - Country:US
Mailing Address - Phone:800-604-2461
Mailing Address - Fax:
Practice Address - Street 1:221 MAIN ST
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94022-2937
Practice Address - Country:US
Practice Address - Phone:800-604-2461
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-21
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty