Provider Demographics
NPI:1124563770
Name:LEE, WHITNEY
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 GASTON AVE
Mailing Address - Street 2:#121
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-5206
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1350 N BUCKNER BLVD
Practice Address - Street 2:220
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-3500
Practice Address - Country:US
Practice Address - Phone:469-855-9107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-05
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX202401106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist