MEDICARE: STACY KATHLEEN 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	80016	CA

General Provider Information

NPI Number	:	1972756500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACY KATHLEEN LEE

Provider Business Mailing Address
First Line	:	3705 HAVEN AVE # 119
Second Line	:
City	:	MENLO PARK
State	:	CA
Zip	:	94025-1011
Country	:	US
Telephone Number	:	650-308-9159
Fax Number	:

Provider Business Practice Location Address
First Line	:	3705 HAVEN AVE # 119
Second Line	:
City	:	MENLO PARK
State	:	CA
Zip	:	94025-1011
Country	:	US
Telephone Number	:	650-308-9159
Fax Number	:

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

Provider Enumeration Date	:	10/28/2008
Last Update Date	:	11/08/2019

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