Provider Demographics
NPI:1093273997
Name:LEE, MEGHAN THERESE (PHD)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:THERESE
Last Name:LEE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 WEWATTA ST APT 702
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-6092
Mailing Address - Country:US
Mailing Address - Phone:970-420-7075
Mailing Address - Fax:
Practice Address - Street 1:7720 S BROADWAY STE 570
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80122-2636
Practice Address - Country:US
Practice Address - Phone:720-242-7533
Practice Address - Fax:720-815-2613
Is Sole Proprietor?:No
Enumeration Date:2019-03-10
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10964103G00000X
COPSY0005243103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist