Basic Information
| Provider Information | |||||||||
| NPI: | 1083378210 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEE | ||||||||
| FirstName: | ADRIANNE | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | TLLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10895 OAK LN APT 15306 | ||||||||
| Address2: | |||||||||
| City: | VAN BUREN TWP | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481114732 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347704102 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5401 MCAULEY DR | ||||||||
| Address2: | |||||||||
| City: | YPSILANTI | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481971011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347862300 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2021 | ||||||||
| LastUpdateDate: | 10/25/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | N | Behavioral Health & Social Service Providers | Behavioral Analyst | 101YM0800X | 6362009368 | MI | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.