Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003208455 |
---|---|
Provider Name | Whitney Lee |
First Address | La Junta, CO 81050-2138 |
Second Address | Lamar, CO 81052-3901 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2015 |
Last Update Date | 23/02/2015 |