Provider Demographics
NPI:1790308195
Name:WALTER J LEE MS LPC EDD
Entity Type:Organization
Organization Name:WALTER J LEE MS LPC EDD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:541-647-0865
Mailing Address - Street 1:61396 S HWY 97 STE 230
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-2558
Mailing Address - Country:US
Mailing Address - Phone:541-647-0865
Mailing Address - Fax:
Practice Address - Street 1:61396 S HWY 97 STE 230
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-2558
Practice Address - Country:US
Practice Address - Phone:541-647-0865
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-20
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty