Provider Demographics
NPI:1568491959
Name:LEE, KAREN ELENA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:ELENA
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 1:2490 N WATER ST
Mailing Address - Street 2:SUITE 9
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-4251
Mailing Address - Country:US
Mailing Address - Phone:217-877-1100
Mailing Address - Fax:217-877-1101
Practice Address - Street 1:2490 N WATER ST
Practice Address - Street 2:SUITE 9
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-4251
Practice Address - Country:US
Practice Address - Phone:217-877-1100
Practice Address - Fax:217-877-1101
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071004726103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical