Provider Demographics
NPI:1801587308
Name:LEE, OMARAN DEVON I (DMIN PT)
Entity type:Individual
Prefix:DR
First Name:OMARAN
Middle Name:DEVON
Last Name:LEE
Suffix:I
Gender:M
Credentials:DMIN PT
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 330191
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-7501
Mailing Address - Country:US
Mailing Address - Phone:615-506-0356
Mailing Address - Fax:
Practice Address - Street 1:5217 GIARDINO DR
Practice Address - Street 2:
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-4265
Practice Address - Country:US
Practice Address - Phone:615-506-0356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-16
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner