Provider Demographics
NPI:1407931652
Name:LEE, LAURENCE (MPSY, LPC, LPA)
Entity Type:Individual
Prefix:
First Name:LAURENCE
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:MPSY, LPC, LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21714 HARDY OAK BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4839
Mailing Address - Country:US
Mailing Address - Phone:210-233-6148
Mailing Address - Fax:
Practice Address - Street 1:21714 HARDY OAK BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4839
Practice Address - Country:US
Practice Address - Phone:210-233-6148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18433101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional