Provider Demographics
NPI:1053072355
Name:LEE, KYUNG (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:KYUNG
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:KYUNG
Other - Middle Name:BOB
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PMHNP-BC
Mailing Address - Street 1:2103 RESEARCH FOREST DR STE 175
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-4162
Mailing Address - Country:US
Mailing Address - Phone:832-895-0347
Mailing Address - Fax:
Practice Address - Street 1:2103 RESEARCH FOREST DR STE 175
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-4162
Practice Address - Country:US
Practice Address - Phone:832-895-0347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-07
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1064072363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty