Healthcare Provider Details

I. General information

NPI: 1376686055
Provider Name (Legal Business Name): NANCY LEE MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NANCY LEE MFT

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1965 LIVE OAK BLVD
YUBA CITY CA
95991-8828
US

IV. Provider business mailing address

1965 LIVE OAK BLVD
YUBA CITY CA
95991-8828
US

V. Phone/Fax

Practice location:
  • Phone: 530-822-7200
  • Fax:
Mailing address:
  • Phone: 530-822-7200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number42104
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: