Provider Demographics
NPI:1174888051
Name:LEE, JOYCE (MSBCBA)
Entity type:Individual
Prefix:MRS
First Name:JOYCE
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:MSBCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 ALPINE VILLA DR
Mailing Address - Street 2:
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91001-1404
Mailing Address - Country:US
Mailing Address - Phone:844-427-8834
Mailing Address - Fax:
Practice Address - Street 1:1031 ALPINE VILLA DR
Practice Address - Street 2:
Practice Address - City:ALTADENA
Practice Address - State:CA
Practice Address - Zip Code:91001-1404
Practice Address - Country:US
Practice Address - Phone:844-427-8834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-06
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
1118288103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA47-568-1176OtherSECRETARY OF STATE OF CALIFORNIA