Provider Demographics
NPI:1306397591
Name:LEE, JARED
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 RALEIGH AVE APT 205
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-2226
Mailing Address - Country:US
Mailing Address - Phone:701-212-3999
Mailing Address - Fax:
Practice Address - Street 1:3100 RALEIGH AVE APT 205
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-2226
Practice Address - Country:US
Practice Address - Phone:701-212-3999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-22
Last Update Date:2016-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor