Provider Demographics
NPI:1063772689
Name:LEE BARROW, LLC
Entity type:Organization
Organization Name:LEE BARROW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:TULL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-937-9152
Mailing Address - Street 1:PO BOX 1533
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33846-1533
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2225 E EDGEWOOD DR
Practice Address - Street 2:SUTIE 11
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-3634
Practice Address - Country:US
Practice Address - Phone:863-937-9152
Practice Address - Fax:863-937-9154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-17
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH4263101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty