Provider Demographics
NPI:1790378420
Name:LEE, GAIL (MS LMFT)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:MS LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 93
Mailing Address - Street 2:
Mailing Address - City:ENCAMPMENT
Mailing Address - State:WY
Mailing Address - Zip Code:82325-0093
Mailing Address - Country:US
Mailing Address - Phone:307-329-6623
Mailing Address - Fax:
Practice Address - Street 1:408 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:WY
Practice Address - Zip Code:82325-5134
Practice Address - Country:US
Practice Address - Phone:307-329-6623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-13
Last Update Date:2021-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY066106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist