| Ettie Lee Youth Family Services | |
|
Ettie Lee 5146 N. Maine Ave. Baldwin Park CA 91706 | |
| (909) 620-2521 | |
| (909) 620-9793 |
| Full Name | Ettie Lee Youth Family Services |
|---|---|
| Speciality | Psychologist - Clinical Child & Adolescent |
| Location | Ettie Lee 5146 N. Maine Ave., Baldwin Park, California |
| Authorized Official Name and Position | Diana Baker (PROGRAM DIRECTOR) |
| Authorized Official Contact | 9095033589 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ettie Lee Youth Family Services 14101 Vai Brothers Dr Rancho Cucamonga CA 91739-2172 Ph: (909) 899-1435 | Ettie Lee Youth Family Services Ettie Lee 5146 N. Maine Ave. Baldwin Park CA 91706 Ph: (909) 620-2521 |
| NPI Number | 1336272111 |
|---|---|
| Provider Enumeration Date | 03/13/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336272111 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | A3813299 (California) | Primary |
| 103TC2200X | Psychologist - Clinical Child & Adolescent | (California) | Primary |
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