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NPI Code Detail

MEDICARE: MR. ANDREW THOMAS LEE LCPC

MEDICARE: MR. ANDREW THOMAS LEE LCPC
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
1101YM0800XMental Health Counselor180.016841IL

General Provider Information

NPI Number : 1457872731
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ANDREW THOMAS LEE LCPC
Provider Business Mailing Address
First Line : 388556 PO BOX
Second Line :
City : CHICAGO
State : IL
Zip : 60638
Country : US
Telephone Number : 708-304-3010
Fax Number :
Provider Business Practice Location Address
First Line : 6815 W 63RD ST
Second Line :
City : CHICAGO
State : IL
Zip : 60638-4048
Country : US
Telephone Number : 708-304-3010
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2017
Last Update Date : 12/24/2025

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