Provider Demographics
NPI:1790244416
Name:LEE, KATELYN (LCSW)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 INDEPENDENCE LANE
Mailing Address - Street 2:P O BOX 493
Mailing Address - City:LAFOLLETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37766-3073
Mailing Address - Country:US
Mailing Address - Phone:423-562-1705
Mailing Address - Fax:423-566-5106
Practice Address - Street 1:130 INDEPENDENCE LANE
Practice Address - Street 2:
Practice Address - City:LAFOLLETTE
Practice Address - State:TN
Practice Address - Zip Code:37766-3073
Practice Address - Country:US
Practice Address - Phone:423-562-1705
Practice Address - Fax:423-566-3718
Is Sole Proprietor?:No
Enumeration Date:2019-03-13
Last Update Date:2023-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN79411041C0700X, 1041C0700X
TN11825104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker