Healthcare Provider Details

I. General information

NPI: 1215255419
Provider Name (Legal Business Name): TSUILEI LAM MACE ED.D., LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2010
Last Update Date: 07/11/2022
Certification Date: 07/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2810 E DEL MAR BLVD STE 5
PASADENA CA
91107-4322
US

IV. Provider business mailing address

530 S LAKE AVE # 187
PASADENA CA
91101-3515
US

V. Phone/Fax

Practice location:
  • Phone: 626-538-9340
  • Fax:
Mailing address:
  • Phone: 626-538-9340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number190258954
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number80116
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: