Provider Demographics
NPI:1457511834
Name:LEES PSYCHOLOGICAL SERVICES, INC.
Entity Type:Organization
Organization Name:LEES PSYCHOLOGICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEES
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, CEDS
Authorized Official - Phone:414-774-6878
Mailing Address - Street 1:601 N 99TH ST
Mailing Address - Street 2:SUITE 307
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4339
Mailing Address - Country:US
Mailing Address - Phone:414-774-6878
Mailing Address - Fax:414-774-6879
Practice Address - Street 1:601 N 99TH ST
Practice Address - Street 2:SUITE 307
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-4339
Practice Address - Country:US
Practice Address - Phone:414-774-6878
Practice Address - Fax:414-774-6879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-10
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1560103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000001286Medicare PIN