Provider Demographics
NPI:1104937689
Name:YEE, JULIE L (MFT)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:L
Last Name:YEE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 TIENDA DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95242-3933
Mailing Address - Country:US
Mailing Address - Phone:209-986-3597
Mailing Address - Fax:
Practice Address - Street 1:1930 TIENDA DR
Practice Address - Street 2:SUITE 102
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242-3933
Practice Address - Country:US
Practice Address - Phone:209-986-3597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2010-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC42313106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20-5884446OtherTIN#: 20-5884446