Provider Demographics
NPI:1467765669
Name:SIGALL, LEE HOWARD (MFT)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:HOWARD
Last Name:SIGALL
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12262 PASEO LUCIDO
Mailing Address - Street 2:SUITE C
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-3256
Mailing Address - Country:US
Mailing Address - Phone:619-300-1968
Mailing Address - Fax:
Practice Address - Street 1:12262 PASEO LUCIDO
Practice Address - Street 2:SUITE C
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-3256
Practice Address - Country:US
Practice Address - Phone:619-300-1968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-16
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC26068106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist