Provider Demographics
NPI:1144783267
Name:LEE, ELIZABETH C (MS)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:C
Last Name:LEE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8668 NAVARRE PKWY # 309
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-2185
Mailing Address - Country:US
Mailing Address - Phone:850-710-3848
Mailing Address - Fax:833-781-1104
Practice Address - Street 1:8155 NAVARRE PKWY
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566-6941
Practice Address - Country:US
Practice Address - Phone:850-710-3848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-08
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
FLIMH21063101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health