Provider Demographics
NPI:1700360070
Name:LEE, BRIAN L (MHS, CADC)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:L
Last Name:LEE
Suffix:
Gender:M
Credentials:MHS, CADC
Other - Prefix:MR
Other - First Name:BRIAN
Other - Middle Name:L
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MHS, CADC
Mailing Address - Street 1:8938 S RIDGELAND AVENUE SUITE 100
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453
Mailing Address - Country:US
Mailing Address - Phone:708-599-1067
Mailing Address - Fax:708-599-1095
Practice Address - Street 1:8938 S RIDGELAND AVENUE SUITE 100
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453
Practice Address - Country:US
Practice Address - Phone:708-599-1067
Practice Address - Fax:708-599-1095
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-21
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL24152101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)