Provider Demographics
NPI:1083454656
Name:LEE, NA (MA, LMFT)
Entity type:Individual
Prefix:
First Name:NA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19301 URANIUM ST NW
Mailing Address - Street 2:
Mailing Address - City:NOWTHEN
Mailing Address - State:MN
Mailing Address - Zip Code:55303-9509
Mailing Address - Country:US
Mailing Address - Phone:651-800-5616
Mailing Address - Fax:
Practice Address - Street 1:7400 FRANCE AVE S
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4738
Practice Address - Country:US
Practice Address - Phone:763-537-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4147106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist