Provider Demographics
NPI:1831600998
Name:LEE, JASON (PHD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:
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 1:1207 CARLSBAD VILLAGE DR STE O
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-1958
Mailing Address - Country:US
Mailing Address - Phone:760-283-0952
Mailing Address - Fax:
Practice Address - Street 1:1207 CARLSBAD VILLAGE DR STE O
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-1958
Practice Address - Country:US
Practice Address - Phone:760-283-0952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-17
Last Update Date:2020-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29431103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical