Provider Demographics
NPI:1881096824
Name:LEE, KIMBERLY
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:PARKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW U/S
Mailing Address - Street 1:312 PAYTON PLACE LAKE HLS
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-4201
Mailing Address - Country:US
Mailing Address - Phone:405-584-0403
Mailing Address - Fax:
Practice Address - Street 1:124 S BROADWAY AVE
Practice Address - Street 2:SUITE 402
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-5820
Practice Address - Country:US
Practice Address - Phone:580-235-0274
Practice Address - Fax:580-235-0277
Is Sole Proprietor?:No
Enumeration Date:2014-09-22
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor