Provider Demographics
NPI:1053837351
Name:LEE, SOON IM
Entity Type:Individual
Prefix:
First Name:SOON
Middle Name:IM
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8811 S TACOMA WAY STE 106
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-4595
Mailing Address - Country:US
Mailing Address - Phone:253-302-3826
Mailing Address - Fax:253-267-5212
Practice Address - Street 1:5116 196TH ST SW STE 101
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-6148
Practice Address - Country:US
Practice Address - Phone:425-776-1290
Practice Address - Fax:425-776-1290
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60277505101YA0400X
WACG60154807101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)