Provider Demographics
NPI:1205879574
Name:LEE, ALISON JAMIE (PHD)
Entity type:Individual
Prefix:DR
First Name:ALISON
Middle Name:JAMIE
Last Name:LEE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5766 OAK BANK TRAIL
Mailing Address - Street 2:104
Mailing Address - City:OAK PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91377
Mailing Address - Country:US
Mailing Address - Phone:310-721-9717
Mailing Address - Fax:
Practice Address - Street 1:28310 ROADSIDE DR STE 140
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-4950
Practice Address - Country:US
Practice Address - Phone:310-721-9717
Practice Address - Fax:818-707-0955
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16130103G00000X, 103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP16130Medicare ID - Type UnspecifiedPSYCHOLOGIST