Provider Demographics
NPI:1093109464
Name:LEE, JQUAN
Entity Type:Individual
Prefix:
First Name:JQUAN
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 BIBLE WAY
Mailing Address - Street 2:SUITE 63
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-2135
Mailing Address - Country:US
Mailing Address - Phone:775-322-4673
Mailing Address - Fax:775-322-4644
Practice Address - Street 1:1000 BIBLE WAY
Practice Address - Street 2:SUITE 63
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-2135
Practice Address - Country:US
Practice Address - Phone:775-322-4673
Practice Address - Fax:775-322-4644
Is Sole Proprietor?:No
Enumeration Date:2015-03-24
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst