Provider Demographics
NPI:1942325568
Name:LEE, MARCIA ANN (MFT)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:ANN
Last Name:LEE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6413 SHINING SAND AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89142-2826
Mailing Address - Country:US
Mailing Address - Phone:702-435-2212
Mailing Address - Fax:702-638-0362
Practice Address - Street 1:5852 S PECOS RD
Practice Address - Street 2:SUITE H-2
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-3489
Practice Address - Country:US
Practice Address - Phone:702-435-2212
Practice Address - Fax:702-638-0362
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0834106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV0834OtherMFT 0834