Provider Demographics
NPI:1972012391
Name:THAO, LEE (LPCC, LADC)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:
Last Name:THAO
Suffix:
Gender:F
Credentials:LPCC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1377 COUNTY ROAD E W
Mailing Address - Street 2:
Mailing Address - City:ARDEN HILLS
Mailing Address - State:MN
Mailing Address - Zip Code:55112-3654
Mailing Address - Country:US
Mailing Address - Phone:612-314-3076
Mailing Address - Fax:079-313-1400
Practice Address - Street 1:2345 RICE ST STE 145
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-3720
Practice Address - Country:US
Practice Address - Phone:612-314-3076
Practice Address - Fax:651-251-4889
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-28
Last Update Date:2023-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN305599101YA0400X
MN3470101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1972012391Medicaid