MEDICARE: MRS. SUSAN JOYE LEE LPC-MHSP, RPT, SUP.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	14555	TX
2	101YM0800X	Mental Health Counselor	2128	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11737193	OTHER	TN	CAQH
2	4154354	OTHER	TN	BCBS OF TN
3	10043951	OTHER	TN	AMERICAN BEHAVIORAL
4	84528L	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1124026794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUSAN JOYE LEE LPC-MHSP, RPT, SUP.

Provider Business Mailing Address
First Line	:	9247 SPEERBERRY CIR
Second Line	:
City	:	CORDOVA
State	:	TN
Zip	:	38016-2399
Country	:	US
Telephone Number	:	901-251-4457
Fax Number	:

Provider Business Practice Location Address
First Line	:	6510 STAGE RD
Second Line	:	SUITE 3
City	:	MEMPHIS
State	:	TN
Zip	:	38134-3892
Country	:	US
Telephone Number	:	901-488-3123
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	08/30/2007

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