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General NPI Number Information
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NPI Number | 1578017125
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Entity Type | Individual
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Provider Name | JEANNIE LY
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Gender | Female
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Dates
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Enumeration Date | 08/12/2016
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Last Update Date | 08/12/2016
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Provider Practice Location Address
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Address Line | 14687 ROUND LEAF RD
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City | MORENO VALLEY
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State | CA
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Zip | 92555-4742
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Country | US
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Telephone | 951-488-1929
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Fax |
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Provider Business Mailing Address
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Address Line | 14687 ROUND LEAF RD
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City | MORENO VALLEY
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State | CA
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Zip | 92555-4742
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PCCI2179
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 101YS0200X
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Taxonomy Name | School Counselor
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License Number |
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License Number State | CA
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