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General NPI Number Information
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NPI Number | 1548507775
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Entity Type | Organization
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Legal Business Name | DR JOHN Y LEE CLINICAL PSYCHOLOGIST
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Dates
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Enumeration Date | 01/08/2013
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Last Update Date | 07/01/2013
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Provider Practice Location Address
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Address Line | 16161 VENTURA BLVD 224
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City | ENCINO
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State | CA
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Zip | 91436-2522
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Country | US
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Telephone | 818-631-8349
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Fax |
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Provider Business Mailing Address
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Address Line | 8349 AURA AVE
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City | NORTHRIDGE
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State | CA
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Zip | 91324-4202
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Country | US
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Telephone | 818-631-8349
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. JOHN Y LEE
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Credential | PHD
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Telephone | 818-631-8349
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 25158
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 25158
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License Number State | CA
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