Provider Demographics
NPI:1285983122
Name:LEE, ANNE H (MS, RD, MA, LMFT)
Entity type:Individual
Prefix:MS
First Name:ANNE
Middle Name:H
Last Name:LEE
Suffix:
Gender:F
Credentials:MS, RD, MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25422 TRABUCO ROAD
Mailing Address - Street 2:SUITE 105-210
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630
Mailing Address - Country:US
Mailing Address - Phone:949-689-8272
Mailing Address - Fax:
Practice Address - Street 1:23832 ROCKFIELD BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-2805
Practice Address - Country:US
Practice Address - Phone:949-689-8272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-06
Last Update Date:2017-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RD#722789133V00000X
CALMFT#77162106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered