Healthcare Provider Details

I. General information

NPI: 1174728943
Provider Name (Legal Business Name): AMY C LEE L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2007
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5152 KATELLA AVE STE 202D
LOS ALAMITOS CA
90720-2817
US

IV. Provider business mailing address

5152 KATELLA AVE STE 202D
LOS ALAMITOS CA
90720-2817
US

V. Phone/Fax

Practice location:
  • Phone: 562-618-4647
  • Fax: 626-856-3010
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCS12731
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: