Provider Demographics
NPI:1891282117
Name:LEE, MARK J (MA,)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:J
Last Name:LEE
Suffix:
Gender:M
Credentials:MA,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 SOUTHWEST HIGHWAY 101
Mailing Address - Street 2:
Mailing Address - City:LINCOLN CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97367
Mailing Address - Country:US
Mailing Address - Phone:541-557-1892
Mailing Address - Fax:
Practice Address - Street 1:412 SOUTHWEST HIGHWAY 101
Practice Address - Street 2:
Practice Address - City:LINCOLN CITY
Practice Address - State:OR
Practice Address - Zip Code:97367
Practice Address - Country:US
Practice Address - Phone:541-557-1892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-23
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty