MEDICARE: MR. YONG LEE L.P.C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	37PC00487600	NJ
2	101YM0800X	Mental Health Counselor	C3542	OR
3	101YM0800X	Mental Health Counselor	PC007980	PA

General Provider Information

NPI Number	:	1356506513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. YONG LEE L.P.C

Provider Business Mailing Address
First Line	:	204 WHITE HORSE PIKE
Second Line	:	2ND FLOOR
City	:	HADDON HEIGHTS
State	:	NJ
Zip	:	08035-1739
Country	:	US
Telephone Number	:	609-314-9719
Fax Number	:

Provider Business Practice Location Address
First Line	:	204 WHITE HORSE PIKE
Second Line	:	2ND FLOOR
City	:	HADDON HEIGHTS
State	:	NJ
Zip	:	08035-1739
Country	:	US
Telephone Number	:	609-314-9719
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2008
Last Update Date	:	09/08/2016

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