Healthcare Provider Details

I. General information

NPI: 1508789165
Provider Name (Legal Business Name): JASPER LEE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 POTRERO ST STE 29-301
SANTA CRUZ CA
95060-2759
US

IV. Provider business mailing address

303 POTRERO ST STE 29-301
SANTA CRUZ CA
95060-2759
US

V. Phone/Fax

Practice location:
  • Phone: 831-216-6203
  • Fax: 831-425-4039
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number133181
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: