Provider Demographics
NPI:1942632732
Name:KEVIN E. LEE MFT
Entity Type:Organization
Organization Name:KEVIN E. LEE MFT
Other - Org Name:KEVIN E LEE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:909-917-5672
Mailing Address - Street 1:8320 MISSION BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92509-2970
Mailing Address - Country:US
Mailing Address - Phone:951-329-9086
Mailing Address - Fax:951-777-2066
Practice Address - Street 1:8320 MISSION BLVD
Practice Address - Street 2:4
Practice Address - City:JURUPA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92509-2970
Practice Address - Country:US
Practice Address - Phone:951-329-9086
Practice Address - Fax:951-777-2066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-02
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC169650251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health