Provider Demographics
NPI:1063979367
Name:LEE, JALEN MARIE
Entity type:Individual
Prefix:
First Name:JALEN
Middle Name:MARIE
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-1056 HUAULAULA LOOP
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-5818
Mailing Address - Country:US
Mailing Address - Phone:808-349-3302
Mailing Address - Fax:
Practice Address - Street 1:91-1056 HUAULAULA LOOP
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-5818
Practice Address - Country:US
Practice Address - Phone:808-349-3302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-23
Last Update Date:2019-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician