Provider Demographics
NPI:1740647940
Name:LEE, SHARON (BA)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:
Other - Last Name:MOREAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 110725
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98411-0725
Mailing Address - Country:US
Mailing Address - Phone:253-241-1788
Mailing Address - Fax:
Practice Address - Street 1:306 S 7TH ST STE 203
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-3776
Practice Address - Country:US
Practice Address - Phone:253-241-1788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-20
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF61140113101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health