Provider Demographics
NPI:1760514939
Name:LEE, SHANNON (LMFT)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, MFT
Mailing Address - Street 1:3111 LOS FELIZ BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90039-1599
Mailing Address - Country:US
Mailing Address - Phone:323-741-0044
Mailing Address - Fax:323-522-6542
Practice Address - Street 1:3111 LOS FELIZ BLVD STE 106
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90039
Practice Address - Country:US
Practice Address - Phone:323-741-0044
Practice Address - Fax:323-522-6542
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2020-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47482106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist