Provider Demographics
NPI:1689732968
Name:LEES, PAMELA PAIGE (LCPC)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:PAIGE
Last Name:LEES
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 CHIPPEWA RUN
Mailing Address - Street 2:
Mailing Address - City:PANA
Mailing Address - State:IL
Mailing Address - Zip Code:62557
Mailing Address - Country:US
Mailing Address - Phone:217-562-3006
Mailing Address - Fax:
Practice Address - Street 1:132 S WATER ST STE 630
Practice Address - Street 2:SUITE A
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62523-1068
Practice Address - Country:US
Practice Address - Phone:217-460-0264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180004133101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional