Provider Demographics
NPI:1245644558
Name:LEE, CHANG WOOK (LPC)
Entity type:Individual
Prefix:
First Name:CHANG
Middle Name:WOOK
Last Name:LEE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:STEVE
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:181 E CALDERWOOD RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-5765
Mailing Address - Country:US
Mailing Address - Phone:240-274-4003
Mailing Address - Fax:
Practice Address - Street 1:3100 N 1ST AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-2513
Practice Address - Country:US
Practice Address - Phone:520-202-1786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-13
Last Update Date:2017-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-16256101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional