Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | LP1813 | MN |
NPI | 1023263456 |
---|---|
Provider Name | Russell F Lee |
First Address | Bemidji, MN 56601-2528 |
Second Address | Bemidji, MN 56601-2528 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/11/2008 |
Last Update Date | 26/11/2008 |