Provider Demographics
NPI:1013723493
Name:LEE, KENNETH WADE (LPC,NCC)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:WADE
Last Name:LEE
Suffix:
Gender:M
Credentials:LPC,NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12510 N LANTERN WAY
Mailing Address - Street 2:
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85755-8953
Mailing Address - Country:US
Mailing Address - Phone:520-248-6601
Mailing Address - Fax:
Practice Address - Street 1:2001 W ORANGE GROVE RD STE 406
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-1141
Practice Address - Country:US
Practice Address - Phone:520-248-6601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
LPC-23520101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health