Provider Demographics
NPI:1548340110
Name:LEE, AILEEN AN-LU (PHD)
Entity type:Individual
Prefix:DR
First Name:AILEEN
Middle Name:AN-LU
Last Name:LEE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 RIM SHADOWS DR
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86336-3458
Mailing Address - Country:US
Mailing Address - Phone:928-203-1774
Mailing Address - Fax:928-203-4703
Practice Address - Street 1:105 ROADRUNNER DR STE 7
Practice Address - Street 2:
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336-3767
Practice Address - Country:US
Practice Address - Phone:928-203-1774
Practice Address - Fax:928-203-4703
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3311103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ518061OtherAHCCCS
AZAZ0614940OtherBCBS
AZ518061OtherAHCCCS
AZZ60796Medicare ID - Type Unspecified