Provider Demographics
NPI:1629441886
Name:BACH, LEE ELLEN (BSL)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:ELLEN
Last Name:BACH
Suffix:
Gender:F
Credentials:BSL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 REED AVE
Mailing Address - Street 2:#900
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-2002
Mailing Address - Country:US
Mailing Address - Phone:610-939-9999
Mailing Address - Fax:
Practice Address - Street 1:1011 REED AVE
Practice Address - Street 2:#900
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-2002
Practice Address - Country:US
Practice Address - Phone:610-939-9999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-09
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH002904103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst