Provider Demographics
NPI:1336494202
Name:LEE, JEREL LAMAR (MFT)
Entity Type:Individual
Prefix:MR
First Name:JEREL
Middle Name:LAMAR
Last Name:LEE
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10378 BELLWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-2510
Mailing Address - Country:US
Mailing Address - Phone:424-274-8556
Mailing Address - Fax:
Practice Address - Street 1:10378 BELLWOOD AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-2510
Practice Address - Country:US
Practice Address - Phone:424-274-8556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA71399106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist