Provider Demographics
NPI:1316129174
Name:LEE, ERIC A (MA)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:A
Last Name:LEE
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1427 W 86TH ST
Mailing Address - Street 2:BOX #299
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-2103
Mailing Address - Country:US
Mailing Address - Phone:317-444-9912
Mailing Address - Fax:
Practice Address - Street 1:1427 W 86TH ST
Practice Address - Street 2:BOX #299
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-2103
Practice Address - Country:US
Practice Address - Phone:317-444-9912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-03
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional