Provider Demographics
NPI:1861640328
Name:LEA, JODIE K (MFTI, MA)
Entity Type:Individual
Prefix:
First Name:JODIE
Middle Name:K
Last Name:LEA
Suffix:
Gender:F
Credentials:MFTI, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 BUTTE HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-3109
Mailing Address - Country:US
Mailing Address - Phone:530-431-8074
Mailing Address - Fax:
Practice Address - Street 1:2062 TALBERT DR
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-7719
Practice Address - Country:US
Practice Address - Phone:530-431-8074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-08
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMFTI-3367106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist