Provider Demographics
NPI:1477672699
Name:LEES, MARK R (CADC-CAS)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:R
Last Name:LEES
Suffix:
Gender:M
Credentials:CADC-CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 APPLE ST STE 3
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-4455
Mailing Address - Country:US
Mailing Address - Phone:760-547-1280
Mailing Address - Fax:
Practice Address - Street 1:1905 APPLE ST STE 3
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-4455
Practice Address - Country:US
Practice Address - Phone:760-547-1280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
CA75237106H00000X
CA01-069225101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist