Healthcare Provider Details

I. General information

NPI: 1114498409
Provider Name (Legal Business Name): LOUIS LEE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2018
Last Update Date: 06/06/2022
Certification Date: 06/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 LONG BEACH BLVD
LONG BEACH CA
90807-2616
US

IV. Provider business mailing address

4422 VIA MAJORCA
CYPRESS CA
90630-3462
US

V. Phone/Fax

Practice location:
  • Phone: 562-427-7671
  • Fax:
Mailing address:
  • Phone: 714-510-6307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number131322
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: