Provider Demographics
NPI:1265914436
Name:STRAND, LUCY MCKENNA
Entity type:Individual
Prefix:
First Name:LUCY
Middle Name:MCKENNA
Last Name:STRAND
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 1:1306 S MANITOU AVE # 102
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-3339
Mailing Address - Country:US
Mailing Address - Phone:925-457-1014
Mailing Address - Fax:
Practice Address - Street 1:1306 S MANITOU AVE
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-3339
Practice Address - Country:US
Practice Address - Phone:925-457-1014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-04
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician