Provider Demographics
NPI:1366840035
Name:CUNNINGHAM, LEE
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:
Last Name:CUNNINGHAM
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 1:1380 VIEWCREST RD
Mailing Address - Street 2:
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-8548
Mailing Address - Country:US
Mailing Address - Phone:651-650-3117
Mailing Address - Fax:651-305-1220
Practice Address - Street 1:311 RAMSEY ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2323
Practice Address - Country:US
Practice Address - Phone:651-650-3117
Practice Address - Fax:651-305-1220
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-12
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN302861101YA0400X
MN1425101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)