Provider Demographics
NPI:1003126772
Name:LEE, PAUL PATRICK (LCSW)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:PATRICK
Last Name:LEE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 SE 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-1404
Mailing Address - Country:US
Mailing Address - Phone:503-235-3433
Mailing Address - Fax:503-235-4762
Practice Address - Street 1:12 SE 14TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-1404
Practice Address - Country:US
Practice Address - Phone:503-235-3433
Practice Address - Fax:503-235-4762
Is Sole Proprietor?:No
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1065OtherOREGON BOARD OF CLINICAL SOCIAL WORKERS