Provider Demographics
NPI:1306867965
Name:LEE, PATRICIA ANITA (MFT)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANITA
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 1:34021 CALLE DE BONANZA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-5026
Mailing Address - Country:US
Mailing Address - Phone:949-493-0931
Mailing Address - Fax:949-489-9064
Practice Address - Street 1:27322 CALLE ARROYO STE B
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-6761
Practice Address - Country:US
Practice Address - Phone:949-246-2781
Practice Address - Fax:949-489-9064
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT39362101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health