Provider Demographics
NPI:1033214309
Name:LEE, JEAN M (DMIN)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:M
Last Name:LEE
Suffix:
Gender:F
Credentials:DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3872
Mailing Address - Street 2:
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85902
Mailing Address - Country:US
Mailing Address - Phone:928-532-3238
Mailing Address - Fax:928-532-3292
Practice Address - Street 1:1141 E. COOLEY ST.,
Practice Address - Street 2:STE O
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901
Practice Address - Country:US
Practice Address - Phone:928-532-3238
Practice Address - Fax:928-532-3292
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC10187101YA0400X
AZLPC10443101YM0800X, 101YP2500X
AZLPC-10443101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health