Provider Demographics
NPI:1023589496
Name:LEE, TERI CAMPBELL
Entity type:Individual
Prefix:
First Name:TERI
Middle Name:CAMPBELL
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TERI
Other - Middle Name:LEE
Other - Last Name:COURTNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1625 NE WELLS ACRES RD
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-5831
Mailing Address - Country:US
Mailing Address - Phone:808-209-0316
Mailing Address - Fax:
Practice Address - Street 1:300 SE REED MARKET RD STE 205
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-2237
Practice Address - Country:US
Practice Address - Phone:541-948-8663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-11
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician