Provider Demographics
NPI:1578641726
Name:LEE, MARTHA (MA, MFT)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9764 BOVILL DR
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-4474
Mailing Address - Country:US
Mailing Address - Phone:916-842-0207
Mailing Address - Fax:916-382-9770
Practice Address - Street 1:32 MAIN ST
Practice Address - Street 2:
Practice Address - City:SUTTER CREEK
Practice Address - State:CA
Practice Address - Zip Code:95685-4231
Practice Address - Country:US
Practice Address - Phone:209-223-5105
Practice Address - Fax:209-223-7679
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 54031101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health