Provider Demographics
NPI:1073864013
Name:LEE, KIMBERLY S (LCSW)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:S
Last Name:LEE
Suffix:
Gender:F
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:PO BOX 3415
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-3415
Mailing Address - Country:US
Mailing Address - Phone:208-699-9065
Mailing Address - Fax:
Practice Address - Street 1:2101 N LAKEWOOD DR STE 220
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2473
Practice Address - Country:US
Practice Address - Phone:208-699-9065
Practice Address - Fax:208-620-3994
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-01
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-36216101YM0800X, 1041C0700X, 251S00000X
WASA60331973101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No251S00000XAgenciesCommunity/Behavioral Health