Provider Demographics
NPI:1477846285
Name:LEE, MARQUISHA RENEE GREEN (PHD)
Entity type:Individual
Prefix:DR
First Name:MARQUISHA
Middle Name:RENEE GREEN
Last Name:LEE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:MARQUISHA
Other - Middle Name:RENEE
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:MADIGAN ARMY MEDICAL CTR
Mailing Address - Street 2:9040A JACKSON AVENUE
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98431-1000
Mailing Address - Country:US
Mailing Address - Phone:253-968-2827
Mailing Address - Fax:253-968-0920
Practice Address - Street 1:MADIGAN ARMY MEDICAL CTR
Practice Address - Street 2:9040A JACKSON AVENUE
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-1000
Practice Address - Country:US
Practice Address - Phone:253-968-2827
Practice Address - Fax:253-968-0920
Is Sole Proprietor?:No
Enumeration Date:2011-05-26
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4022103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist