Provider Demographics
NPI:1013302009
Name:LEE, KEYNA (LCDC , MS)
Entity type:Individual
Prefix:
First Name:KEYNA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:LCDC , MS
Other - Prefix:
Other - First Name:KEYNA
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCDC
Mailing Address - Street 1:400 TERRELL HWY
Mailing Address - Street 2:
Mailing Address - City:KAUFMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75142-1750
Mailing Address - Country:US
Mailing Address - Phone:830-928-9666
Mailing Address - Fax:
Practice Address - Street 1:400 TERRELL HWY
Practice Address - Street 2:
Practice Address - City:KAUFMAN
Practice Address - State:TX
Practice Address - Zip Code:75142-1750
Practice Address - Country:US
Practice Address - Phone:830-928-9666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-06
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10613101YA0400X
374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10613OtherTEXAS LICENSE LCDC