Provider Demographics
NPI:1265572242
Name:LEE, JUDITH ANN (LMFT)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:ANN
Last Name:LEE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5717 TUCKERMAN LN
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-1938
Mailing Address - Country:US
Mailing Address - Phone:719-593-9775
Mailing Address - Fax:719-266-9989
Practice Address - Street 1:6208 LEHMAN DR
Practice Address - Street 2:SUITE 106
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-8408
Practice Address - Country:US
Practice Address - Phone:719-661-8024
Practice Address - Fax:719-266-9989
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO622101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO11681273OtherCAQH
CO622OtherMARRIEAGE AND FAMILY THER