Provider Demographics
NPI:1811608441
Name:LEE, JASON WAYNE (MS, LMHC)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:WAYNE
Last Name:LEE
Suffix:
Gender:M
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2819 SW BRIGHTON WAY
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-6071
Mailing Address - Country:US
Mailing Address - Phone:561-373-3350
Mailing Address - Fax:
Practice Address - Street 1:2819 SW BRIGHTON WAY
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-6071
Practice Address - Country:US
Practice Address - Phone:561-373-3350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty