Provider Demographics
NPI:1598284887
Name:LEE, CHUI-TAN
Entity Type:Individual
Prefix:MS
First Name:CHUI-TAN
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 1:7780 SE 21ST AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-6260
Mailing Address - Country:US
Mailing Address - Phone:503-433-1184
Mailing Address - Fax:833-392-1184
Practice Address - Street 1:7780 SE 21ST AVE UNIT B
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-6260
Practice Address - Country:US
Practice Address - Phone:503-433-1184
Practice Address - Fax:833-392-1184
Is Sole Proprietor?:No
Enumeration Date:2017-09-18
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ORR5974106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program