Provider Demographics
NPI:1215085378
Name:LEE, LAURA JEAN (MFT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:JEAN
Last Name:LEE
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 1:24980 TERRENO DR
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-3989
Mailing Address - Country:US
Mailing Address - Phone:951-693-2486
Mailing Address - Fax:
Practice Address - Street 1:29377 RANCHO CALIFORNIA RD
Practice Address - Street 2:SUITE 201
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-5206
Practice Address - Country:US
Practice Address - Phone:951-693-2486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32603106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist