Provider Demographics
NPI:1801919691
Name:MARY LEE & ASSOCIATES LIMITED
Entity type:Organization
Organization Name:MARY LEE & ASSOCIATES LIMITED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:708-983-8030
Mailing Address - Street 1:4710 LINCOLN HWY
Mailing Address - Street 2:SUITE # 167
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-2316
Mailing Address - Country:US
Mailing Address - Phone:708-983-8030
Mailing Address - Fax:708-283-2544
Practice Address - Street 1:2555 LINCOLN HWY
Practice Address - Street 2:SUITE # 108C
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1936
Practice Address - Country:US
Practice Address - Phone:708-983-8030
Practice Address - Fax:708-283-2544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071004127103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK02822Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID #
IL207936Medicare ID - Type Unspecified