Provider Demographics
NPI:1477815827
Name:LEE, GLENELL M (PHD)
Entity type:Individual
Prefix:DR
First Name:GLENELL
Middle Name:M
Last Name:LEE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1656 E UNION ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38703-3250
Mailing Address - Country:US
Mailing Address - Phone:662-332-5360
Mailing Address - Fax:662-332-5363
Practice Address - Street 1:1656 E UNION ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38703-3250
Practice Address - Country:US
Practice Address - Phone:662-332-5360
Practice Address - Fax:662-332-5363
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC1291104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker