Provider Demographics
NPI:1407927866
Name:LEE, LAURA ATSUKO (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ATSUKO
Last Name:LEE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:ATSUKO
Other - Last Name:SHIOZAKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:600 S COMMONWEALTH AVE
Mailing Address - Street 2:6TH FLOOR
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90005-4001
Mailing Address - Country:US
Mailing Address - Phone:323-323-2673
Mailing Address - Fax:
Practice Address - Street 1:600 S COMMONWEALTH AVE
Practice Address - Street 2:6TH FLOOR
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005-4001
Practice Address - Country:US
Practice Address - Phone:323-323-2673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS7657101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health