Provider Demographics
NPI:1235541178
Name:LEE, VERNON MAURICE JR
Entity Type:Individual
Prefix:MR
First Name:VERNON
Middle Name:MAURICE
Last Name:LEE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:VERNON
Other - Middle Name:M
Other - Last Name:LEE
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:6021 E 40TH TER
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64129-1717
Mailing Address - Country:US
Mailing Address - Phone:816-861-4700
Mailing Address - Fax:816-922-4604
Practice Address - Street 1:4801 E LINWOOD BLVD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64128-2226
Practice Address - Country:US
Practice Address - Phone:816-861-4700
Practice Address - Fax:816-922-4604
Is Sole Proprietor?:No
Enumeration Date:2014-05-27
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS706101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)