Provider Demographics
NPI:1568480747
Name:LEE, LAURIE K (MS, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:K
Last Name:LEE
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 FULLERTON AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-3160
Mailing Address - Country:US
Mailing Address - Phone:951-737-7361
Mailing Address - Fax:951-737-2119
Practice Address - Street 1:1820 FULLERTON AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-3160
Practice Address - Country:US
Practice Address - Phone:951-737-7361
Practice Address - Fax:951-737-2119
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33979106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist