Provider Demographics
NPI:1992007785
Name:LEE, MARK L (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:L
Last Name:LEE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:934 E CHOCOLATE AVE
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-1215
Mailing Address - Country:US
Mailing Address - Phone:717-665-2675
Mailing Address - Fax:717-256-0599
Practice Address - Street 1:24511 W JAYNE AVE
Practice Address - Street 2:COALINGA STATE HOSPITAL
Practice Address - City:COALINGA
Practice Address - State:CA
Practice Address - Zip Code:93210-9503
Practice Address - Country:US
Practice Address - Phone:559-935-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-30
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS019334103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist