Provider Demographics
NPI:1144370727
Name:LESTER, PATRICIA L (PHD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:L
Last Name:LESTER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95502-0014
Mailing Address - Country:US
Mailing Address - Phone:707-502-9981
Mailing Address - Fax:
Practice Address - Street 1:837 3RD ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-0511
Practice Address - Country:US
Practice Address - Phone:707-441-1053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21546103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY30615058Medicaid
KY3383Medicare ID - Type UnspecifiedMEDICARE
KY30615058Medicaid
KYS79396Medicare UPIN