Provider Demographics
NPI:1326240250
Name:COHEN, LEE MICHAEL (PSYCHOLOGIST)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:MICHAEL
Last Name:COHEN
Suffix:
Gender:M
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1602 10TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79401-2607
Mailing Address - Country:US
Mailing Address - Phone:806-766-0310
Mailing Address - Fax:806-744-9580
Practice Address - Street 1:1950 ASPEN
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79404
Practice Address - Country:US
Practice Address - Phone:806-766-0310
Practice Address - Fax:806-744-9580
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31730103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX31730OtherLICENSE