Provider Demographics
NPI:1477288876
Name:HUGHES, LIDA GRACE
Entity Type:Individual
Prefix:
First Name:LIDA
Middle Name:GRACE
Last Name:HUGHES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1083 VINE ST STE 320
Mailing Address - Street 2:
Mailing Address - City:HEALDSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:95448-4830
Mailing Address - Country:US
Mailing Address - Phone:707-395-7550
Mailing Address - Fax:707-723-0330
Practice Address - Street 1:132 MILL ST STE 210
Practice Address - Street 2:
Practice Address - City:HEALDSBURG
Practice Address - State:CA
Practice Address - Zip Code:95448-4462
Practice Address - Country:US
Practice Address - Phone:707-395-7550
Practice Address - Fax:707-723-0330
Is Sole Proprietor?:No
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist