Provider Demographics
NPI:1922338722
Name:THE CLINEBELL INSTITUTE
Entity Type:Organization
Organization Name:THE CLINEBELL INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR OF THE CLINEBELL
Authorized Official - Prefix:DR
Authorized Official - First Name:KYUNGSIG
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:626-616-2478
Mailing Address - Street 1:1325 NORTH COLLEGE AVENUE
Mailing Address - Street 2:3RD FLOOR BUTLER BUILDING
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-3154
Mailing Address - Country:US
Mailing Address - Phone:909-451-3690
Mailing Address - Fax:909-447-6351
Practice Address - Street 1:1325 NORTH COLLEGE AVENUE
Practice Address - Street 2:3RD FLOOR BUTLER BUILDING
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-3154
Practice Address - Country:US
Practice Address - Phone:909-451-3690
Practice Address - Fax:909-447-6351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-30
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22920103T00000X
CA16926106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty