Provider Demographics
NPI:1831341304
Name:LEE, GREGORY JAY (RN)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:JAY
Last Name:LEE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 GREENTRAILS DR S
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-2917
Mailing Address - Country:US
Mailing Address - Phone:314-434-6986
Mailing Address - Fax:314-434-6986
Practice Address - Street 1:328 GREENTRAILS DR S
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-2917
Practice Address - Country:US
Practice Address - Phone:314-434-6986
Practice Address - Fax:314-434-6986
Is Sole Proprietor?:No
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO114871101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health