Healthcare Provider Details

I. General information

NPI: 1922338722
Provider Name (Legal Business Name): THE CLINEBELL INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2009
Last Update Date: 12/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 NORTH COLLEGE AVENUE 3RD FLOOR BUTLER BUILDING
CLAREMONT CA
91711-3154
US

IV. Provider business mailing address

1325 NORTH COLLEGE AVENUE 3RD FLOOR BUTLER BUILDING
CLAREMONT CA
91711-3154
US

V. Phone/Fax

Practice location:
  • Phone: 909-451-3690
  • Fax: 909-447-6351
Mailing address:
  • Phone: 909-451-3690
  • Fax: 909-447-6351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number22920
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number16926
License Number StateCA

VIII. Authorized Official

Name: DR. KYUNGSIG SAMUEL LEE
Title or Position: EXECUTIVE DIRECTOR OF THE CLINEBELL
Credential: PH.D.
Phone: 626-616-2478