Basic Information
| Provider Information | |||||||||
| NPI: | 1730516972 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEE | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3408 KRAUSHAAR RD | ||||||||
| Address2: | |||||||||
| City: | STANDISH | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486589716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9893131421 | ||||||||
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| Practice Location | |||||||||
| Address1: | 901 CHIPPEWA ST | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485031552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8102329950 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2013 | ||||||||
| LastUpdateDate: | 10/02/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | MI | Y | Behavioral Health & Social Service Providers | Counselor | 103T00000X | N | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.