Provider Demographics
NPI:1437427952
Name:LEE, KEVIN DALE (CPRSS)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:DALE
Last Name:LEE
Suffix:
Gender:M
Credentials:CPRSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4750 S HARVARD AVE
Mailing Address - Street 2:SUITE #81
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-3031
Mailing Address - Country:US
Mailing Address - Phone:918-895-8699
Mailing Address - Fax:
Practice Address - Street 1:4750 S HARVARD AVE
Practice Address - Street 2:SUITE #81
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-3031
Practice Address - Country:US
Practice Address - Phone:918-895-8699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNONE/NOT-REQUIRED101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor