Provider Demographics
NPI:1770320400
Name:LEE, KATY (MA)
Entity type:Individual
Prefix:
First Name:KATY
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:KAITLAN
Other - Middle Name:NICOLE
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2709 SECLUSION DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-3620
Mailing Address - Country:US
Mailing Address - Phone:208-874-2361
Mailing Address - Fax:
Practice Address - Street 1:4020 FOLKER ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5386
Practice Address - Country:US
Practice Address - Phone:907-261-5582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health