MEDICARE: MRS. LAURIE K LEE MS, LMFT

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	33979	CA

General Provider Information

NPI Number	:	1568480747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAURIE K LEE MS, LMFT

Provider Business Mailing Address
First Line	:	1820 FULLERTON AVE
Second Line	:	SUITE 210
City	:	CORONA
State	:	CA
Zip	:	92881-3160
Country	:	US
Telephone Number	:	951-737-7361
Fax Number	:	951-737-2119

Provider Business Practice Location Address
First Line	:	1820 FULLERTON AVE
Second Line	:	SUITE 210
City	:	CORONA
State	:	CA
Zip	:	92881-3160
Country	:	US
Telephone Number	:	951-737-7361
Fax Number	:	951-737-2119

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

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	07/08/2007

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