Provider Demographics
NPI:1740247048
Name:LEE, JULIE D (LCSW)
Entity type:Individual
Prefix:MS
First Name:JULIE
Middle Name:D
Last Name:LEE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E 11TH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46016-1779
Mailing Address - Country:US
Mailing Address - Phone:765-622-1991
Mailing Address - Fax:765-778-8328
Practice Address - Street 1:200 E 11TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46016-1779
Practice Address - Country:US
Practice Address - Phone:765-622-1991
Practice Address - Fax:765-778-8328
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34001426A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN508970Medicare ID - Type Unspecified