Provider Demographics
NPI:1023479656
Name:ANNE H LEE MARRIAGE AND FAMILY THERAPY, INC.
Entity type:Organization
Organization Name:ANNE H LEE MARRIAGE AND FAMILY THERAPY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BOARD OF DIRECTORS/PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:HON
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, MA, LMFT
Authorized Official - Phone:949-689-8272
Mailing Address - Street 1:25422 TRABUCO RD
Mailing Address - Street 2:SUITE 105-210
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-2791
Mailing Address - Country:US
Mailing Address - Phone:949-689-8272
Mailing Address - Fax:
Practice Address - Street 1:23832 ROCKFIELD BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-2805
Practice Address - Country:US
Practice Address - Phone:949-689-8272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-09
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACALMFT77162251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health