Provider Demographics
NPI:1154527984
Name:LEE, ROBERT EDWARD
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:EDWARD
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55931 SNOW GOOSE RD
Mailing Address - Street 2:
Mailing Address - City:SUNRIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97707-2352
Mailing Address - Country:US
Mailing Address - Phone:541-593-1544
Mailing Address - Fax:
Practice Address - Street 1:55931 SNOW GOOSE RD
Practice Address - Street 2:
Practice Address - City:SUNRIVER
Practice Address - State:OR
Practice Address - Zip Code:97707-2352
Practice Address - Country:US
Practice Address - Phone:541-593-1544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health