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NPI Code Detail

MEDICARE: VIVIAN LEE M.F.T.

MEDICARE: VIVIAN LEE M.F.T.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family TherapistMFC47209CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1ENK1875OTHERCALOS ANGELES COUNTY - DMH

General Provider Information

NPI Number : 1154457067
Entity Type Code : Individual
Provider Name (Legal Business Name) : VIVIAN LEE M.F.T.
Provider Business Mailing Address
First Line : PO BOX 1074
Second Line :
City : MONTEBELLO
State : CA
Zip : 90640-1074
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1000 GOODRICH BLVD
Second Line :
City : COMMERCE
State : CA
Zip : 90022-5103
Country : US
Telephone Number : 323-832-9795
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/26/2007
Last Update Date : 07/20/2009

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