Provider Demographics
NPI:1801183652
Name:LEE, EVELYN JOY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:EVELYN
Middle Name:JOY
Last Name:LEE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15300 VENTURA BLVD
Mailing Address - Street 2:503-A
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-3103
Mailing Address - Country:US
Mailing Address - Phone:818-519-8297
Mailing Address - Fax:818-991-5938
Practice Address - Street 1:15300 VENTURA BLVD
Practice Address - Street 2:503-A
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-3103
Practice Address - Country:US
Practice Address - Phone:818-519-8297
Practice Address - Fax:818-991-5938
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-30
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY23300103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist