Provider Demographics
NPI:1659478063
Name:LEE, THOMAS (PSYD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 CAMINO DEL RIO S STE 314
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3860
Mailing Address - Country:US
Mailing Address - Phone:619-491-3643
Mailing Address - Fax:619-293-0268
Practice Address - Street 1:2801 CAMINO DEL RIO S STE 314
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3860
Practice Address - Country:US
Practice Address - Phone:619-491-3643
Practice Address - Fax:619-293-0268
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10788103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical