Provider Demographics
NPI:1477192029
Name:LUCID LIVING, LLC.
Entity type:Organization
Organization Name:LUCID LIVING, LLC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:D
Authorized Official - Last Name:JONES
Authorized Official - Suffix:II
Authorized Official - Credentials:DNP, PMHNP-BC, CPC
Authorized Official - Phone:360-539-8899
Mailing Address - Street 1:PO BOX 110804
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98411-0804
Mailing Address - Country:US
Mailing Address - Phone:360-539-8899
Mailing Address - Fax:360-539-1744
Practice Address - Street 1:15413 1ST AVENUE CT S STE 1A
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98444-4631
Practice Address - Country:US
Practice Address - Phone:360-539-8999
Practice Address - Fax:360-539-1744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-31
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251E00000XAgenciesHome Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health