Provider Demographics
NPI:1487676953
Name:LEE, JULIA A (PHD)
Entity Type:Individual
Prefix:DR
First Name:JULIA
Middle Name:A
Last Name:LEE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 GRAND AVE
Mailing Address - Street 2:305
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-7505
Mailing Address - Country:US
Mailing Address - Phone:562-901-2053
Mailing Address - Fax:562-901-2137
Practice Address - Street 1:211 E OCEAN BLVD
Practice Address - Street 2:259
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-4809
Practice Address - Country:US
Practice Address - Phone:562-901-2053
Practice Address - Fax:562-901-2137
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13978103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY139780Medicaid
CAOPL139780OtherBLUE SHIELD
CAPSY139780Medicaid