Provider Demographics
NPI:1215069513
Name:LEE, CHAVA CHERTA (MS)
Entity type:Individual
Prefix:
First Name:CHAVA
Middle Name:CHERTA
Last Name:LEE
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6815 W CAPITOL DR
Mailing Address - Street 2:SUITE 107
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-2070
Mailing Address - Country:US
Mailing Address - Phone:414-461-3569
Mailing Address - Fax:414-461-3667
Practice Address - Street 1:6815 W CAPITOL DR
Practice Address - Street 2:SUITE 107
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-2070
Practice Address - Country:US
Practice Address - Phone:414-461-3569
Practice Address - Fax:414-461-3667
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI39788000101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health