Provider Demographics
NPI:1831463058
Name:LEE, SEAN EDWARD
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:EDWARD
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5609 NW 107TH TER
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-7002
Mailing Address - Country:US
Mailing Address - Phone:405-694-3746
Mailing Address - Fax:405-603-6363
Practice Address - Street 1:5609 NW 107TH TER
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73162-7002
Practice Address - Country:US
Practice Address - Phone:405-694-3746
Practice Address - Fax:405-603-6363
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-06
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker