Provider Demographics
NPI:1669577102
Name:LEE, ROLAND N (PHD)
Entity type:Individual
Prefix:DR
First Name:ROLAND
Middle Name:N
Last Name:LEE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5170 SANDERLIN AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-4360
Mailing Address - Country:US
Mailing Address - Phone:901-761-2622
Mailing Address - Fax:901-761-2355
Practice Address - Street 1:5170 SANDERLIN AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-4360
Practice Address - Country:US
Practice Address - Phone:901-761-2622
Practice Address - Fax:901-761-2355
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP883103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNR70801Medicare UPIN
TN368499Medicare ID - Type Unspecified