| Doctor Name: | MISS MISTY DAWN DEE |
| NPI Number: | 1063753648 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CSAC II |
| License Number: | D1012011415 |
| Business Practice Address: | 2494 Lake Tahoe Blvd Suite B-5 South Lake Tahoe, CA - 961517509 |
| Business Phone Number: | 5305414594 |
| Business Fax Number: | |
| Mailing Address: | Po Box 17509, SOUTH LAKE TAHOE |
| State: | CA |
| Postal Code: | 961517509 |
| Phone Number: | 5305414594 |
| Fax Number: | |
| NPI Enumeration Date: | 03/07/2013 |
| NPI Last Update Date: | 03/07/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | D1012011415 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |