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General NPI Number Information
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NPI Number | 1922338722
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Entity Type | Organization
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Legal Business Name | THE CLINEBELL INSTITUTE
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Dates
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Enumeration Date | 12/30/2009
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Last Update Date | 12/30/2009
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Provider Practice Location Address
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Address Line | 1325 NORTH COLLEGE AVENUE 3RD FLOOR BUTLER BUILDING
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City | CLAREMONT
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State | CA
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Zip | 91711-3154
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Country | US
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Telephone | 909-451-3690
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Fax | 909-447-6351
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Provider Business Mailing Address
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Address Line | 1325 NORTH COLLEGE AVENUE 3RD FLOOR BUTLER BUILDING
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City | CLAREMONT
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State | CA
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Zip | 91711-3154
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Country | US
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Telephone | 909-451-3690
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Fax | 909-447-6351
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR OF THE CLINEBELL
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Name | DR. KYUNGSIG SAMUEL LEE
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Credential | PH.D.
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Telephone | 626-616-2478
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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 | 16926
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 22920
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License Number State | CA
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