Active NPI
Timothy Lee
- Marriage & Family Therapist
- Sacramento, CA
National Provider Identifier
1730607144
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 111330
- Practice address
- 4612 Roosevelt Ave
Sacramento, CA 95820-4520 - Phone
- (916) 379-5876
- NPI assigned
- Sep 6, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | |||
| Case Manager/Care Coordinator | 171M00000X | |||
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Marriage & Family Therapist | 106H00000X | 111330 | CA | Primary |
Addresses
Primary practice location
4612 Roosevelt Ave
Sacramento, CA 95820-4520
Mailing address
18525 Sutter Blvd Ste 200
Morgan Hill, CA 95037-2899
Phone (408) 762-7022
Other practice location 1
900 Fulton Ave Ste 205
Sacramento, CA 95825-4517
Phone (916) 484-3570 ext. 116
Other practice location 2
7171 Bowling Dr Ste 300
Sacramento, CA 95823-2043
Phone (916) 394-9195
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730607144 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 111330 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1504656000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1647302400000",
"number": "1730607144",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18525 SUTTER BLVD STE 200",
"city": "MORGAN HILL",
"state": "CA",
"postal_code": "950372899",
"telephone_number": "408-762-7022"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4612 ROOSEVELT AVE",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958204520",
"telephone_number": "916-379-5876"
}
],
"practiceLocations": [
{
"address_1": "900 Fulton Ave Ste 205",
"address_purpose": "LOCATION",
"city": "Sacramento",
"state": "CA",
"postal_code": "958254517",
"country_code": "US",
"telephone_number": "916-484-3570 x116",
"fax_number": "916-429-7824",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "7171 Bowling Dr Ste 300",
"address_purpose": "LOCATION",
"city": "Sacramento",
"state": "CA",
"postal_code": "958232043",
"country_code": "US",
"telephone_number": "916-394-9195",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "LEE",
"first_name": "TIMOTHY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-09-06",
"last_updated": "2022-03-15",
"certification_date": "2022-03-15",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": null,
"license": null,
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "111330",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1730607144",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sacramento, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.