Provider Demographics
NPI:1407952682
Name:LEE, ROBERT E (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:E
Last Name:LEE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 WAGON TRAIL LN
Mailing Address - Street 2:NONE
Mailing Address - City:GOLDSBY
Mailing Address - State:OK
Mailing Address - Zip Code:73093-9154
Mailing Address - Country:US
Mailing Address - Phone:405-288-6288
Mailing Address - Fax:
Practice Address - Street 1:2530 S. COMMERCE BLDG A
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73402
Practice Address - Country:US
Practice Address - Phone:580-223-5070
Practice Address - Fax:580-223-5617
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical