Provider Demographics
NPI:1457905804
Name:LEE, JUSTIN SR (LMSW)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:LEE
Suffix:SR
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 N TOURMALINE WAY APT 2
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-7734
Mailing Address - Country:US
Mailing Address - Phone:501-545-6403
Mailing Address - Fax:
Practice Address - Street 1:140 N TOURMALINE WAY APT 2
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-7734
Practice Address - Country:US
Practice Address - Phone:501-545-6403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-24
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR8903-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical