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NPI Code Detail

MEDICARE: MS. JACQUELINE K. LEE

MEDICARE: MS. JACQUELINE K. 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
2101YM0800XMental Health Counselor
3101YP2500XProfessional Counselor
4106H00000XMarriage & Family Therapist

General Provider Information

NPI Number : 1295497733
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JACQUELINE K. LEE
Provider Business Mailing Address
First Line : 1918 OLIVE ST APT 2802
Second Line :
City : DALLAS
State : TX
Zip : 75201-2291
Country : US
Telephone Number : 412-508-0722
Fax Number :
Provider Business Practice Location Address
First Line : 618 CLARA BARTON BLVD STE 7
Second Line :
City : GARLAND
State : TX
Zip : 75042-5731
Country : US
Telephone Number : 214-385-5445
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2021
Last Update Date : 10/12/2021

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