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NPI Code Detail

MEDICARE: YEJI LEE ACSW

MEDICARE: YEJI LEE ACSW
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
1101YM0800XMental Health Counselor
2390200000XStudent in an Organized Health Care Education/Training Program
31041C0700XClinical Social Worker108707CA

General Provider Information

NPI Number : 1891298758
Entity Type Code : Individual
Provider Name (Legal Business Name) : YEJI LEE ACSW
Provider Business Mailing Address
First Line : 2945 MCMILLAN AVE STE 240
Second Line :
City : SAN LUIS OBISPO
State : CA
Zip : 93401-6771
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2945 MCMILLAN AVE STE 240
Second Line :
City : SAN LUIS OBISPO
State : CA
Zip : 93401-6771
Country : US
Telephone Number : 805-439-4890
Fax Number : 805-439-4891
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2018
Last Update Date : 07/01/2022

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