Healthcare Provider Details

I. General information

NPI: 1013204379
Provider Name (Legal Business Name): RACHEL MIRANDA CLEE MS, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2011
Last Update Date: 11/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 EXECUTIVE PARK BLVD SUITE 4000
SAN FRANCISCO CA
94134-3303
US

IV. Provider business mailing address

1663 MISSION ST SUITE 460
SAN FRANCISCO CA
94103-2400
US

V. Phone/Fax

Practice location:
  • Phone: 415-715-1050
  • Fax: 415-715-1051
Mailing address:
  • Phone: 415-715-1050
  • Fax: 415-715-1051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number96153
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: