Provider Demographics
NPI:1407187842
Name:PICKETT-ALLEN, LEE BERTHA
Entity Type:Individual
Prefix:
First Name:LEE BERTHA
Middle Name:
Last Name:PICKETT-ALLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3440 BUCKINGHAM RD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90016-4121
Mailing Address - Country:US
Mailing Address - Phone:323-733-0418
Mailing Address - Fax:626-398-3895
Practice Address - Street 1:1460 N LAKE AVE STE 107
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91104-2300
Practice Address - Country:US
Practice Address - Phone:626-398-3796
Practice Address - Fax:626-398-3895
Is Sole Proprietor?:No
Enumeration Date:2010-01-25
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)