Provider Demographics
NPI:1699545129
Name:LEE, MELISSA (AMFT)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44345 MICHIGAN CT
Mailing Address - Street 2:
Mailing Address - City:INDIAN WELLS
Mailing Address - State:CA
Mailing Address - Zip Code:92210-7206
Mailing Address - Country:US
Mailing Address - Phone:760-668-3880
Mailing Address - Fax:
Practice Address - Street 1:44345 MICHIGAN CT
Practice Address - Street 2:
Practice Address - City:INDIAN WELLS
Practice Address - State:CA
Practice Address - Zip Code:92210-7206
Practice Address - Country:US
Practice Address - Phone:760-668-3880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA128773106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist