Provider Demographics
NPI:1548507775
Name:DR JOHN Y LEE CLINICAL PSYCHOLOGIST
Entity type:Organization
Organization Name:DR JOHN Y LEE CLINICAL PSYCHOLOGIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:Y
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:818-631-8349
Mailing Address - Street 1:8349 AURA AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-4202
Mailing Address - Country:US
Mailing Address - Phone:818-631-8349
Mailing Address - Fax:
Practice Address - Street 1:16161 VENTURA BLVD
Practice Address - Street 2:224
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2522
Practice Address - Country:US
Practice Address - Phone:818-631-8349
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-08
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25158261QM0801X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty