Provider Demographics
NPI:1710123674
Name:LEE, MARY ELIZABETH (LISW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:LEE
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:KEHOE
Other - Middle Name:MARY
Other - Last Name:ELIZABETH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW
Mailing Address - Street 1:600 5TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-6085
Mailing Address - Country:US
Mailing Address - Phone:515-232-2051
Mailing Address - Fax:515-232-2775
Practice Address - Street 1:600 5TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-6085
Practice Address - Country:US
Practice Address - Phone:515-232-2051
Practice Address - Fax:515-232-2775
Is Sole Proprietor?:No
Enumeration Date:2008-12-24
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00203101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional