Provider Demographics
NPI:1568533404
Name:LEE, LUANNE HARRIS (LUANNE LEE MA)
Entity Type:Individual
Prefix:MS
First Name:LUANNE
Middle Name:HARRIS
Last Name:LEE
Suffix:
Gender:F
Credentials:LUANNE LEE MA
Other - Prefix:
Other - First Name:LUANNE
Other - Middle Name:H
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LUANNE LEE MA
Mailing Address - Street 1:87 LENA CT
Mailing Address - Street 2:
Mailing Address - City:CORRALES
Mailing Address - State:NM
Mailing Address - Zip Code:87048-8555
Mailing Address - Country:US
Mailing Address - Phone:505-922-9548
Mailing Address - Fax:
Practice Address - Street 1:4308 CARLISLE BLVD NE
Practice Address - Street 2:SUITE 203
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-4856
Practice Address - Country:US
Practice Address - Phone:505-450-9548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM006196101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional