Provider Demographics
NPI:1932280674
Name:LEE, GARY F (PSYD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:F
Last Name:LEE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P O BOX 1155
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37077
Mailing Address - Country:US
Mailing Address - Phone:615-822-1222
Mailing Address - Fax:615-822-8306
Practice Address - Street 1:131 SANDERS FERRY RD
Practice Address - Street 2:SUITE 203
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075
Practice Address - Country:US
Practice Address - Phone:615-822-1222
Practice Address - Fax:615-822-8306
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2159103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3831349Medicare ID - Type Unspecified