Provider Demographics
NPI:1962190132
Name:STANSBERRY, LEE (MA, PLPC, NCC)
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:
Last Name:STANSBERRY
Suffix:
Gender:F
Credentials:MA, PLPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4921 LOUGHBOROUGH AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63109-3745
Mailing Address - Country:US
Mailing Address - Phone:573-231-6396
Mailing Address - Fax:
Practice Address - Street 1:1300 HAMPTON AVE STE 200
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63139-3163
Practice Address - Country:US
Practice Address - Phone:573-231-6396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021016081101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional