Provider Demographics
NPI:1821148370
Name:HORTON, LEE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:
Last Name:HORTON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1355 LYNNFIELD RD
Mailing Address - Street 2:SUITE 245
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5801
Mailing Address - Country:US
Mailing Address - Phone:901-818-5450
Mailing Address - Fax:901-818-5452
Practice Address - Street 1:1355 LYNNFIELD RD
Practice Address - Street 2:SUITE 245
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-5801
Practice Address - Country:US
Practice Address - Phone:901-818-5450
Practice Address - Fax:901-818-5452
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP1076103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3685936Medicare ID - Type Unspecified