Provider Demographics
NPI:1649596461
Name:LEE, CINDY (LCSW, LADC)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:LCSW, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2311 TERRA TRL
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-3441
Mailing Address - Country:US
Mailing Address - Phone:405-812-5104
Mailing Address - Fax:
Practice Address - Street 1:3908 N PENIEL AVE STE 420
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:OK
Practice Address - Zip Code:73008-3402
Practice Address - Country:US
Practice Address - Phone:405-812-5104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-19
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK46091041C0700X
OK1066101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)