=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265979025
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SEUNGEUN LEE LMHC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2017
-----------------------------------------------------
Last Update Date | 02/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 480 LYNNFIELD ST
-----------------------------------------------------
City | LYNN
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01904-1419
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-477-3950
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 490 BOSTON POST RD APT A117
-----------------------------------------------------
City | WAYLAND
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01778-1842
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-697-1248
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | LMHC10000954
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------