| Ettie Lee - Covina | |
|
754 E Arrow Hwy Suite F Covina CA 91722-2107 | |
| (626) 967-5082 | |
| (626) 859-5002 |
| Full Name | Ettie Lee - Covina |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 754 E Arrow Hwy, Covina, California |
| Authorized Official Name and Position | Terri Varnum (PRESIDENT & CEO) |
| Authorized Official Contact | 6269604861 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ettie Lee - Covina 5146 Maine Ave P.o.box 339 Baldwin Park CA 91706-1658 Ph: (626) 960-4861 | Ettie Lee - Covina 754 E Arrow Hwy Suite F Covina CA 91722-2107 Ph: (626) 967-5082 |
| NPI Number | 1245458546 |
|---|---|
| Provider Enumeration Date | 04/23/2007 |
| Last Update Date | 07/29/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245458546 | NPI | - | NPPES |
| 7453A | Other | CA | MENTAL HEALTH |
| 7008 | Other | CA | DRUG & ALCOHOL |
| 7712 | Other | CA | OTHER - MENTAL HEALTH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | 197802737 (California) | Primary |
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