MEDICARE: SHANNON LEE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor		CA

General Provider Information

NPI Number	:	1073456125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON LEE

Provider Business Mailing Address
First Line	:	3605 LONG BEACH BLVD STE 210
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-6017
Country	:	US
Telephone Number	:	562-380-0261
Fax Number	:

Provider Business Practice Location Address
First Line	:	3605 LONG BEACH BLVD STE 210
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-6017
Country	:	US
Telephone Number	:	562-380-0261
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2026
Last Update Date	:	04/13/2026

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Directions to “ SHANNON LEE ” Practice Location

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