Provider Demographics
NPI:1336294313
Name:LEE, AMY MARIE (MA)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:LEE
Suffix:
Gender:
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 148TH ST W APT 109
Mailing Address - Street 2:
Mailing Address - City:ROSEMOUNT
Mailing Address - State:MN
Mailing Address - Zip Code:55068-6533
Mailing Address - Country:US
Mailing Address - Phone:218-329-7727
Mailing Address - Fax:
Practice Address - Street 1:14665 GALAXIE AVE STE 210
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-4510
Practice Address - Country:US
Practice Address - Phone:952-431-6033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)