Healthcare Provider Details

I. General information

NPI: 1003487182
Provider Name (Legal Business Name): JANICE LEI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2021
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 N HOLLYWOOD WAY STE 102
BURBANK CA
91505-5031
US

IV. Provider business mailing address

12821 NEWPORT AVE
TUSTIN CA
92780-2711
US

V. Phone/Fax

Practice location:
  • Phone: 866-727-8274
  • Fax:
Mailing address:
  • Phone: 866-727-8274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number18293
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number152044
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: