Provider Demographics
NPI:1023349016
Name:LEE, LAURA (MS)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 S SWOOPE AVE
Mailing Address - Street 2:SUITE 211
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-5704
Mailing Address - Country:US
Mailing Address - Phone:407-622-0444
Mailing Address - Fax:407-699-0444
Practice Address - Street 1:225 S SWOOPE AVE
Practice Address - Street 2:SUITE 211
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-5704
Practice Address - Country:US
Practice Address - Phone:407-622-0444
Practice Address - Fax:407-699-0444
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-15
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH5747101YM0800X
FL1-01-0696103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst