Provider Demographics
NPI:1154943702
Name:LEE, JESSICA (LMFT, CSAC)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:LMFT, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98-211 PALI MOMI ST STE 635
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-4322
Mailing Address - Country:US
Mailing Address - Phone:808-518-1707
Mailing Address - Fax:
Practice Address - Street 1:98-211 PALI MOMI ST STE 635
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4322
Practice Address - Country:US
Practice Address - Phone:808-518-1707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-16
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMFT-637106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist