Healthcare Provider Details

I. General information

NPI: 1043834476
Provider Name (Legal Business Name): ANDREW JOON LEE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2020
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2316 S CEDAR ST
LANSING MI
48910-3152
US

IV. Provider business mailing address

PO BOX 30161
LANSING MI
48909-7661
US

V. Phone/Fax

Practice location:
  • Phone: 517-887-4302
  • Fax: 517-887-4437
Mailing address:
  • Phone: 517-887-4383
  • Fax: 517-244-7174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801116852
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: