Provider Demographics
NPI:1215715537
Name:LESA S. VANDER BIE, MA, MFT
Entity type:Organization
Organization Name:LESA S. VANDER BIE, MA, MFT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE & FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LESA
Authorized Official - Middle Name:SHAWN
Authorized Official - Last Name:VANDER BIE
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:949-653-4464
Mailing Address - Street 1:1000 QUAIL STREET
Mailing Address - Street 2:SUITE 192
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660
Mailing Address - Country:US
Mailing Address - Phone:949-653-4464
Mailing Address - Fax:
Practice Address - Street 1:1000 QUAIL STREET
Practice Address - Street 2:SUITE 192
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660
Practice Address - Country:US
Practice Address - Phone:949-653-4464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty