Provider Demographics
NPI:1457872731
Name:LEE, ANDREW THOMAS (MA)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:THOMAS
Last Name:LEE
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5435 S LONG AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-2919
Mailing Address - Country:US
Mailing Address - Phone:708-573-4125
Mailing Address - Fax:
Practice Address - Street 1:6200 CERMAK RD FL 2
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-2322
Practice Address - Country:US
Practice Address - Phone:708-788-8808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-27
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health