Provider Demographics
NPI:1255807046
Name:LEES, ELEXIS TIFFANY
Entity type:Individual
Prefix:MISS
First Name:ELEXIS
Middle Name:TIFFANY
Last Name:LEES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7617 19TH LN SE APT 207
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-5309
Mailing Address - Country:US
Mailing Address - Phone:360-204-4702
Mailing Address - Fax:
Practice Address - Street 1:7617 19TH LN SE APT 207
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-5309
Practice Address - Country:US
Practice Address - Phone:360-204-4702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-18
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty