Basic Information
| Provider Information | |||||||||
| NPI: | 1184061715 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEE | ||||||||
| FirstName: | KATHRYN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.A., BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 425 UNIVERSITY AVE | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958256520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164482050 | ||||||||
| FaxNumber: | 9164486050 | ||||||||
| Practice Location | |||||||||
| Address1: | 425 UNIVERSITY AVE | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958256520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164482050 | ||||||||
| FaxNumber: | 9164486050 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2013 | ||||||||
| LastUpdateDate: | 05/22/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | #1-13-13277 | CA | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.