Basic Information
| Provider Information | |||||||||
| NPI: | 1528248887 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEE | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | C. | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2200 THORNE ST | ||||||||
| Address2: | |||||||||
| City: | NEWBERG | ||||||||
| State: | OR | ||||||||
| PostalCode: | 971329517 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5039805672 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1675 WINTER ST NE | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973017152 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035850351 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/05/2007 | ||||||||
| LastUpdateDate: | 11/05/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | C1840 | OR | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.