Provider Demographics
NPI:1679818330
Name:LEE, LANI ELEANOR (MA, MFT)
Entity Type:Individual
Prefix:MRS
First Name:LANI
Middle Name:ELEANOR
Last Name:LEE
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:MS
Other - First Name:LANI
Other - Middle Name:
Other - Last Name:MILETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:651 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-4202
Mailing Address - Country:US
Mailing Address - Phone:707-331-5246
Mailing Address - Fax:
Practice Address - Street 1:651 CHERRY ST
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-4202
Practice Address - Country:US
Practice Address - Phone:707-331-5246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC51375106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist