Healthcare Provider Details

I. General information

NPI: 1851181887
Provider Name (Legal Business Name): CHRISTIE PRINCE LEP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2025
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 CROWN POINT CIR
GRASS VALLEY CA
95945-9089
US

IV. Provider business mailing address

18543 WOLF CREEK RD
GRASS VALLEY CA
95949-6912
US

V. Phone/Fax

Practice location:
  • Phone: 530-478-6400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number4643
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: