=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528489069
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CAROL DOWNIE LEE M.F.T.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/31/2013
-----------------------------------------------------
Last Update Date | 12/31/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1350 CHERRY ST.
-----------------------------------------------------
City | SAN CARLOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94070-6888
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-274-3140
-----------------------------------------------------
Fax | 650-591-0728
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 6888
-----------------------------------------------------
City | SAN CARLOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94070-6888
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-274-3140
-----------------------------------------------------
Fax | 650-591-0728
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 004495
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------