Provider Demographics
NPI:1336420132
Name:LEE, COLLEEN G (FPMHNP-BC)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:G
Last Name:LEE
Suffix:
Gender:F
Credentials:FPMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1931 NW MILITARY HWY STE 206
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-2162
Mailing Address - Country:US
Mailing Address - Phone:210-580-4626
Mailing Address - Fax:210-468-7246
Practice Address - Street 1:1931 NW MILITARY HWY STE 206
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-2162
Practice Address - Country:US
Practice Address - Phone:210-580-4626
Practice Address - Fax:210-468-7246
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-07
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP120897363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX285462204Medicaid
TX285462205OtherCSHCN