Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PY11255 | FL |
Y | 103T00000X | Psychologist | PY11255 | FL |
N | 103TE1100X | Exercise & Sports Psychologist | PY11255 | FL |
N | 103TR0400X | Rehabilitation Psychologist | PY11255 | FL |
NPI | 1063174894 |
---|---|
Provider Name | Dr. Jaylene M Lee |
First Address | Tampa, FL 33612-4745 |
Second Address | Tampa, FL 33612-4745 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/10/2021 |
Last Update Date | 12/10/2021 |