Provider Demographics
NPI:1326498627
Name:LEE, AUDRA T (MS, MA, LPC, LMHC)
Entity Type:Individual
Prefix:
First Name:AUDRA
Middle Name:T
Last Name:LEE
Suffix:
Gender:F
Credentials:MS, MA, LPC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 SE DIVISION ST STE 104
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-1055
Mailing Address - Country:US
Mailing Address - Phone:503-964-6608
Mailing Address - Fax:
Practice Address - Street 1:1235 SE DIVISION ST STE 104
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-1055
Practice Address - Country:US
Practice Address - Phone:503-964-6608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-16
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60892451101YM0800X
ORC4919101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health