Provider Demographics
NPI:1639792781
Name:LUCID COUNSELING AND WELLNESS
Entity Type:Organization
Organization Name:LUCID COUNSELING AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:830-444-6281
Mailing Address - Street 1:612 E HONDO AVE
Mailing Address - Street 2:
Mailing Address - City:DEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:78016-3320
Mailing Address - Country:US
Mailing Address - Phone:830-444-6281
Mailing Address - Fax:
Practice Address - Street 1:612 E HONDO AVE
Practice Address - Street 2:
Practice Address - City:DEVINE
Practice Address - State:TX
Practice Address - Zip Code:78016-3320
Practice Address - Country:US
Practice Address - Phone:830-444-6281
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-23
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX382289202Medicaid