Provider Demographics
NPI:1891300646
Name:LEE, NICHOLAS (LMHC)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4103 N NORMANDIE ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-1045
Mailing Address - Country:US
Mailing Address - Phone:505-201-9635
Mailing Address - Fax:
Practice Address - Street 1:4103 N NORMANDIE ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-1045
Practice Address - Country:US
Practice Address - Phone:505-201-9635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-09
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60924696101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2077844Medicaid