Provider Demographics
NPI:1285090936
Name:LEE, KA V (LPC)
Entity type:Individual
Prefix:
First Name:KA
Middle Name:V
Last Name:LEE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3321 S 12TH ST
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-6753
Mailing Address - Country:US
Mailing Address - Phone:920-783-6201
Mailing Address - Fax:920-783-6203
Practice Address - Street 1:3321 S 12TH ST
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-6753
Practice Address - Country:US
Practice Address - Phone:920-783-6201
Practice Address - Fax:920-783-6203
Is Sole Proprietor?:No
Enumeration Date:2016-01-11
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5901-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional