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General NPI Number Information
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NPI Number | 1295880961
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Entity Type | Individual
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Provider Name | KEVIN E LEE M.F.T.
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Gender | Male
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 375 S MAIN ST STE 107
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City | POMONA
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State | CA
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Zip | 91766-1639
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Country | US
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Telephone | 909-868-0300
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Fax | 909-947-9598
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Provider Business Mailing Address
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Address Line | 2314 S AUGUSTA PL
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City | ONTARIO
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State | CA
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Zip | 91761-5772
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Country | US
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Telephone | 909-868-0300
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Fax | 909-947-9598
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MF169650
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License Number State | CA
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