Provider Demographics
NPI:1720327414
Name:LEE, ANALISA
Entity Type:Individual
Prefix:
First Name:ANALISA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 92
Mailing Address - Street 2:
Mailing Address - City:QUINAULT
Mailing Address - State:WA
Mailing Address - Zip Code:98575-0092
Mailing Address - Country:US
Mailing Address - Phone:360-224-3323
Mailing Address - Fax:
Practice Address - Street 1:329 S SHORE RD
Practice Address - Street 2:
Practice Address - City:QUINAULT
Practice Address - State:WA
Practice Address - Zip Code:98575
Practice Address - Country:US
Practice Address - Phone:360-224-3323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-31
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALPCC11433101YP2500X
WALH60506344101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional