Provider Demographics
NPI:1902046774
Name:LEE, KATHLEEN ELIZABETH (LAC, LMFT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ELIZABETH
Last Name:LEE
Suffix:
Gender:F
Credentials:LAC, LMFT
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC, LMFT
Mailing Address - Street 1:13323 W WASHINGTON BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-5163
Mailing Address - Country:US
Mailing Address - Phone:310-614-0637
Mailing Address - Fax:
Practice Address - Street 1:13323 W WASHINGTON BLVD STE 202
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-5163
Practice Address - Country:US
Practice Address - Phone:310-614-0637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-05
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38850106H00000X
CA12956171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist