Provider Demographics
NPI:1083806392
Name:LEE, SALLY ELIZABETH (MA)
Entity Type:Individual
Prefix:MS
First Name:SALLY
Middle Name:ELIZABETH
Last Name:LEE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 102
Mailing Address - Street 2:
Mailing Address - City:DULZURA
Mailing Address - State:CA
Mailing Address - Zip Code:91917-0102
Mailing Address - Country:US
Mailing Address - Phone:619-850-2144
Mailing Address - Fax:619-468-3006
Practice Address - Street 1:18372 HIGHWAY 94
Practice Address - Street 2:
Practice Address - City:DULZURA
Practice Address - State:CA
Practice Address - Zip Code:91917-1216
Practice Address - Country:US
Practice Address - Phone:619-850-2144
Practice Address - Fax:619-468-3006
Is Sole Proprietor?:No
Enumeration Date:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health