Provider Demographics
NPI:1316505621
Name:LEE-WOLFE, COURTNEY ROSE
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:ROSE
Last Name:LEE-WOLFE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:ROSE BENIPAYO
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4511 S 308TH ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98001-2602
Mailing Address - Country:US
Mailing Address - Phone:510-846-0253
Mailing Address - Fax:
Practice Address - Street 1:200 1ST AVE W STE 312
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98119-4219
Practice Address - Country:US
Practice Address - Phone:510-846-0253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-31
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60949329101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health