Provider Demographics
NPI:1578917399
Name:LEE, JOSHUA R (MS, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:R
Last Name:LEE
Suffix:
Gender:M
Credentials:MS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 DOTY ST
Mailing Address - Street 2:
Mailing Address - City:EDGERTON
Mailing Address - State:WI
Mailing Address - Zip Code:53534-1521
Mailing Address - Country:US
Mailing Address - Phone:608-770-3803
Mailing Address - Fax:
Practice Address - Street 1:4465 MILTON AVE STE 107
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53546-9145
Practice Address - Country:US
Practice Address - Phone:608-770-3803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-18
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7021-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health