Provider Demographics
NPI:1700020765
Name:LEE, JERI LYNN (EDD)
Entity Type:Individual
Prefix:DR
First Name:JERI
Middle Name:LYNN
Last Name:LEE
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:916 GRACELAND CT
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-4245
Mailing Address - Country:US
Mailing Address - Phone:615-859-4016
Mailing Address - Fax:
Practice Address - Street 1:916 GRACELAND CT
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-4245
Practice Address - Country:US
Practice Address - Phone:615-859-4016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP0000001963103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst