Basic Information
| Provider Information | |||||||||
| NPI: | 1518136514 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEE | ||||||||
| FirstName: | YUN | ||||||||
| MiddleName: | JUNG | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1055 E BALTIMORE PIKE | ||||||||
| Address2: | |||||||||
| City: | MEDIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190635173 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108923800 | ||||||||
| FaxNumber: | 4844681412 | ||||||||
| Practice Location | |||||||||
| Address1: | 1055 E BALTIMORE PIKE | ||||||||
| Address2: | |||||||||
| City: | MEDIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190635173 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108923800 | ||||||||
| FaxNumber: | 4844681412 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2008 | ||||||||
| LastUpdateDate: | 12/17/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | PC004690 | PA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.