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NPI Code Detail

MEDICARE: MS. JACQUELINE LEE

MEDICARE: MS. JACQUELINE LEE
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
1101Y00000XCounselor
2103K00000XBehavior Analyst1-16-23678NM
3106S00000XBehavior Technician

General Provider Information

NPI Number : 1255711388
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JACQUELINE LEE
Provider Business Mailing Address
First Line : 8500 WASHINGTON ST NE STE A1
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87113-1861
Country : US
Telephone Number : 505-828-3837
Fax Number :
Provider Business Practice Location Address
First Line : 8500 WASHINGTON ST NE STE A1
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87113-1861
Country : US
Telephone Number : 505-828-3837
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2015
Last Update Date : 09/30/2016

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Directions to “ MS. JACQUELINE LEE ” Practice Location

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