Basic Information
| Provider Information | |||||||||
| NPI: | 1174013098 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEE | ||||||||
| FirstName: | MIN HEE | ||||||||
| MiddleName: | |||||||||
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| Credential: | BCBA | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 5 REVERE DR STE 120 | ||||||||
| Address2: | |||||||||
| City: | NORTHBROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600628005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8478073917 | ||||||||
| FaxNumber: | 8473483706 | ||||||||
| Practice Location | |||||||||
| Address1: | 5 REVERE DR STE 120 | ||||||||
| Address2: | |||||||||
| City: | NORTHBROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600628005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8478073917 | ||||||||
| FaxNumber: | 8473483706 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2018 | ||||||||
| LastUpdateDate: | 07/08/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-20-42268 | IL | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.