Provider Demographics
NPI:1891510566
Name:HUR LEE, NIKITA
Entity type:Individual
Prefix:
First Name:NIKITA
Middle Name:
Last Name:HUR 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 1:8819 HIDDENSPRING WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-6166
Mailing Address - Country:US
Mailing Address - Phone:916-896-6160
Mailing Address - Fax:
Practice Address - Street 1:3230 PEACEKEEPER WAY BLDG 209
Practice Address - Street 2:
Practice Address - City:MCCLELLAN
Practice Address - State:CA
Practice Address - Zip Code:95652-2609
Practice Address - Country:US
Practice Address - Phone:916-923-4579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA808611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical