Provider Demographics
NPI:1093054421
Name:LEE, JASON Y (BA)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:Y
Last Name:LEE
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17800 WOODRUFF AVE STE F
Mailing Address - Street 2:
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706-7080
Mailing Address - Country:US
Mailing Address - Phone:562-866-8956
Mailing Address - Fax:
Practice Address - Street 1:17800 WOODRUFF AVE STE F
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-7080
Practice Address - Country:US
Practice Address - Phone:562-866-8956
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-05
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CAD4513538101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health