Provider Demographics
NPI:1306356100
Name:LEE, THERESA
Entity Type:Individual
Prefix:
First Name:THERESA
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 1:535 SADDLE DR
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-5634
Mailing Address - Country:US
Mailing Address - Phone:406-302-1333
Mailing Address - Fax:406-449-8828
Practice Address - Street 1:535 SADDLE DR
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-5634
Practice Address - Country:US
Practice Address - Phone:406-302-1333
Practice Address - Fax:406-449-8828
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-05
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT257531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical