Provider Demographics
NPI:1447382320
Name:LEE, JENNIFER L (MA, LMFT)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:L
Last Name:LEE
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 SUNRISE AVE
Mailing Address - Street 2:SUITE A-19
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4519
Mailing Address - Country:US
Mailing Address - Phone:916-316-3198
Mailing Address - Fax:916-209-3434
Practice Address - Street 1:901 SUNRISE AVE
Practice Address - Street 2:SUITE A-19
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4519
Practice Address - Country:US
Practice Address - Phone:916-316-3198
Practice Address - Fax:916-209-3434
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC49993106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist