Provider Demographics
NPI:1578173860
Name:LEE, MIRAN
Entity Type:Individual
Prefix:
First Name:MIRAN
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4127 BAROSSA VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-0225
Mailing Address - Country:US
Mailing Address - Phone:254-723-4153
Mailing Address - Fax:
Practice Address - Street 1:4127 BAROSSA VALLEY LN
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-0225
Practice Address - Country:US
Practice Address - Phone:254-723-4153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor