Healthcare Provider Details

I. General information

NPI: 1205484227
Provider Name (Legal Business Name): JUSTIN D OH-LEE LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2019
Last Update Date: 04/10/2024
Certification Date: 04/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5816 EASTMAN AVE
MIDLAND MI
48640-6792
US

IV. Provider business mailing address

100 NB GRATIOT AVE
MOUNT CLEMENS MI
48043-2301
US

V. Phone/Fax

Practice location:
  • Phone: 989-244-1888
  • Fax: 989-321-6544
Mailing address:
  • Phone: 586-783-2950
  • Fax: 586-690-4333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801105660
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: