=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912201476
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANNA LEE LMFT93402
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/27/2010
-----------------------------------------------------
Last Update Date | 04/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1211 W VISTA WAY BLDG C
-----------------------------------------------------
City | VISTA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92083-6227
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-721-2781
-----------------------------------------------------
Fax | 760-721-9571
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 125 W F ST SUITE 101
-----------------------------------------------------
City | ONTARIO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91762-3201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-986-4550
-----------------------------------------------------
Fax | 909-986-4506
-----------------------------------------------------
=====================================================
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 | LMFT93402
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------