Provider Demographics
NPI:1245383215
Name:LEE, MICHELLE (MFT)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
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 1:2830 G ST STE D2
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-4447
Mailing Address - Country:US
Mailing Address - Phone:707-268-5654
Mailing Address - Fax:855-975-2610
Practice Address - Street 1:2830 G ST STE D2
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-4447
Practice Address - Country:US
Practice Address - Phone:707-268-5654
Practice Address - Fax:855-975-2610
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-20
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35463101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA35463OtherRELEVANT MEDICAL INFORMATION