Healthcare Provider Details

I. General information

NPI: 1740460476
Provider Name (Legal Business Name): JOSEPH Y LEE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2007
Last Update Date: 07/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1885 UNIVERSITY AVE W SUITE 25
SAINT PAUL MN
55104-3489
US

IV. Provider business mailing address

5 WOODLAND DR
BURNSVILLE MN
55337-2707
US

V. Phone/Fax

Practice location:
  • Phone: 612-203-1207
  • Fax: 651-645-1885
Mailing address:
  • Phone: 612-203-1207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberLP1967
License Number StateMN

VIII. Authorized Official

Name: MR. JOSEPH Y LEE
Title or Position: DIRECTOR
Credential: M.A.L.P.
Phone: 612-203-1207