Provider Demographics
NPI:1407732522
Name:LEE, SELAH GRACE
Entity type:Individual
Prefix:MRS
First Name:SELAH
Middle Name:GRACE
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 ALTA AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-6438
Mailing Address - Country:US
Mailing Address - Phone:831-295-2072
Mailing Address - Fax:
Practice Address - Street 1:555 GLENWOOD DR
Practice Address - Street 2:
Practice Address - City:SCOTTS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95066-3262
Practice Address - Country:US
Practice Address - Phone:831-439-9555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-13
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist