Provider Demographics
NPI:1265953939
Name:LEE, GARRETT (CATC IV)
Entity type:Individual
Prefix:
First Name:GARRETT
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:CATC IV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6800 OWENSMOUTH AVE STE 160
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-4255
Mailing Address - Country:US
Mailing Address - Phone:213-310-2873
Mailing Address - Fax:
Practice Address - Street 1:6800 OWENSMOUTH AVE STE 160
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-4255
Practice Address - Country:US
Practice Address - Phone:818-610-6771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-03
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAII051300218101YA0400X
CA164498IV101YA0400X
101YM0800X, 171M00000X, 172A00000X, 172V00000X, 175T00000X, 225C00000X, 251B00000X, 251S00000X, 253Z00000X, 225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172A00000XOther Service ProvidersDriver
No172V00000XOther Service ProvidersCommunity Health Worker
No175T00000XOther Service ProvidersPeer Specialist
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care