Provider Demographics
NPI:1083038160
Name:LEE, LISA (MFT, CSAC)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:MFT, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98-211 PALI MOMI ST STE 803
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-4380
Mailing Address - Country:US
Mailing Address - Phone:808-782-5964
Mailing Address - Fax:
Practice Address - Street 1:98-211 PALI MOMI ST STE 803
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4380
Practice Address - Country:US
Practice Address - Phone:808-782-5964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-11
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI383106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist