Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003236746 |
---|---|
Provider Name | Stacy Lee |
First Address | Woodland, CA 95695-2779 |
Second Address | Woodland, CA 95695-2779 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2014 |
Last Update Date | 21/04/2014 |