MEDICARE: MELISSA LEE

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
1	106H00000X	Marriage & Family Therapist	88016	CA

General Provider Information

NPI Number	:	1518341791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA LEE

Provider Business Mailing Address
First Line	:	4902 BRAND WAY
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95819-2242
Country	:	US
Telephone Number	:	916-212-3179
Fax Number	:

Provider Business Practice Location Address
First Line	:	3650 AUBURN BLVD STE 206
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95821-2069
Country	:	US
Telephone Number	:	916-212-3179
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2015
Last Update Date	:	01/08/2016

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