Provider Demographics
NPI:1780851709
Name:LEE, JINSOON
Entity type:Individual
Prefix:
First Name:JINSOON
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JIN
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10107 RIDGEGATE PKWY STE 310
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-5642
Mailing Address - Country:US
Mailing Address - Phone:303-861-2663
Mailing Address - Fax:
Practice Address - Street 1:10107 RIDGEGATE PKWY STE 310
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5642
Practice Address - Country:US
Practice Address - Phone:303-861-2663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-08
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171W00000X
COPSY.0004500103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No171W00000XOther Service ProvidersContractor