Provider Demographics
NPI:1427612464
Name:LEE, MORRIS DANIEL
Entity type:Individual
Prefix:
First Name:MORRIS
Middle Name:DANIEL
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MORRIS
Other - Middle Name:DAN'L
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, LCPC
Mailing Address - Street 1:3716 W BRIGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-2938
Mailing Address - Country:US
Mailing Address - Phone:309-338-7911
Mailing Address - Fax:
Practice Address - Street 1:3716 W BRIGHTON AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-2938
Practice Address - Country:US
Practice Address - Phone:309-692-7755
Practice Address - Fax:309-692-2262
Is Sole Proprietor?:No
Enumeration Date:2019-04-25
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178013344101YM0800X
IL180013122101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health