Healthcare Provider Details

I. General information

NPI: 1306363569
Provider Name (Legal Business Name): MILEE LAWRENCE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2017
Last Update Date: 04/04/2022
Certification Date: 04/04/2022
Deactivation Date: 03/12/2018
Reactivation Date: 04/17/2019

III. Provider practice location address

5445 LAUREL HILLS DR
SACRAMENTO CA
95841-3105
US

IV. Provider business mailing address

3212 LUSCUTOFF CT
SACRAMENTO CA
95820-2159
US

V. Phone/Fax

Practice location:
  • Phone: 916-609-5100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-19-76652
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: