Provider Demographics
NPI:1346619947
Name:LEE, MECHTILD BERNADETTE (TLMFT)
Entity Type:Individual
Prefix:MRS
First Name:MECHTILD
Middle Name:BERNADETTE
Last Name:LEE
Suffix:
Gender:F
Credentials:TLMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 CIMARRON DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IA
Mailing Address - Zip Code:52302-9791
Mailing Address - Country:US
Mailing Address - Phone:319-651-9685
Mailing Address - Fax:
Practice Address - Street 1:420 6TH ST SE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52401-1903
Practice Address - Country:US
Practice Address - Phone:319-364-7121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-24
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA075171101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health