Provider Demographics
NPI:1508953282
Name:LEE, JAMIE DENISE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:DENISE
Last Name:LEE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7835 S RAINBOW BLVD STE 17
Mailing Address - Street 2:PMB #2
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89139-6457
Mailing Address - Country:US
Mailing Address - Phone:307-679-1912
Mailing Address - Fax:
Practice Address - Street 1:7835 S RAINBOW BLVD STE 17
Practice Address - Street 2:PMB #2
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89139-6457
Practice Address - Country:US
Practice Address - Phone:307-679-1912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY0543103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDLM49EAOtherCAREFIRST BCBS GROUP
517251OtherUHC MAMSI
R968OtherCAREFIRST FEDERAL GROUP
MD742LMedicare ID - Type Unspecified