Provider Demographics
NPI:1346709953
Name:LEE, ADRIEN ELAINE
Entity Type:Individual
Prefix:
First Name:ADRIEN
Middle Name:ELAINE
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 1:9706 NEW YORK CT APT B
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-9183
Mailing Address - Country:US
Mailing Address - Phone:419-320-5147
Mailing Address - Fax:
Practice Address - Street 1:9706 NEW YORK CT APT B
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-9183
Practice Address - Country:US
Practice Address - Phone:419-320-5147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-14
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician