Provider Demographics
NPI:1245010875
Name:LEE, NELSON (ACMHC)
Entity type:Individual
Prefix:
First Name:NELSON
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:ACMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1486 WESTBURY WAY APT L
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-4887
Mailing Address - Country:US
Mailing Address - Phone:801-808-5866
Mailing Address - Fax:
Practice Address - Street 1:12401 S 450 E UNIT B2
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-7936
Practice Address - Country:US
Practice Address - Phone:385-439-0169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13565339-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health