Provider Demographics
NPI:1386742302
Name:LEE, JODI MICHELE (MA LMHC)
Entity type:Individual
Prefix:MS
First Name:JODI
Middle Name:MICHELE
Last Name:LEE
Suffix:
Gender:F
Credentials:MA LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 EMERALD COAST CLUB BLVD
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32407-4506
Mailing Address - Country:US
Mailing Address - Phone:850-249-1547
Mailing Address - Fax:
Practice Address - Street 1:700 W 23RD ST
Practice Address - Street 2:SUITE 100
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-3936
Practice Address - Country:US
Practice Address - Phone:850-747-5411
Practice Address - Fax:850-872-7354
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1774A101YA0400X
FLMH5746101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health