Provider Demographics
NPI:1114167160
Name:LEE, JOON BEOM (ASW-REGISTERED)
Entity Type:Individual
Prefix:MR
First Name:JOON
Middle Name:BEOM
Last Name:LEE
Suffix:
Gender:M
Credentials:ASW-REGISTERED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 SO. LAFAYETTE PARK PLACE
Mailing Address - Street 2:
Mailing Address - City:LA
Mailing Address - State:CA
Mailing Address - Zip Code:90057-5400
Mailing Address - Country:US
Mailing Address - Phone:213-252-2100
Mailing Address - Fax:213-383-3146
Practice Address - Street 1:520 SO. LAFAYETTE PARK PLACE
Practice Address - Street 2:
Practice Address - City:LA
Practice Address - State:CA
Practice Address - Zip Code:90057-5400
Practice Address - Country:US
Practice Address - Phone:213-252-2100
Practice Address - Fax:213-383-3146
Is Sole Proprietor?:No
Enumeration Date:2009-03-04
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW68761101YM0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program