Provider Demographics
NPI:1699061515
Name:RATHBUN, LUCINDA ANN (MFTI #63054)
Entity type:Individual
Prefix:
First Name:LUCINDA
Middle Name:ANN
Last Name:RATHBUN
Suffix:
Gender:F
Credentials:MFTI #63054
Other - Prefix:
Other - First Name:LUCINDA
Other - Middle Name:ANN
Other - Last Name:DAVENPORT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:438 COLUSA AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-4148
Mailing Address - Country:US
Mailing Address - Phone:530-755-0735
Mailing Address - Fax:530-755-0737
Practice Address - Street 1:438 COLUSA AVE
Practice Address - Street 2:SUITE A
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-4148
Practice Address - Country:US
Practice Address - Phone:530-755-0735
Practice Address - Fax:530-755-0737
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 63054106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist