Provider Demographics
NPI:1427223015
Name:LEE, INNA
Entity Type:Individual
Prefix:
First Name:INNA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 801751
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91380-1751
Mailing Address - Country:US
Mailing Address - Phone:323-204-8111
Mailing Address - Fax:
Practice Address - Street 1:23822 VALENCIA BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-5302
Practice Address - Country:US
Practice Address - Phone:323-204-8111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-24
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 48514106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist