Provider Demographics
NPI:1225867880
Name:LEE, HANEUL (MED)
Entity type:Individual
Prefix:
First Name:HANEUL
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:JENNIE
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MED
Mailing Address - Street 1:2122 KRATKY RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63114-1706
Mailing Address - Country:US
Mailing Address - Phone:314-825-4450
Mailing Address - Fax:844-519-7811
Practice Address - Street 1:2122 KRATKY RD STE 100
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63114-1706
Practice Address - Country:US
Practice Address - Phone:314-825-4450
Practice Address - Fax:844-519-7811
Is Sole Proprietor?:No
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health