MEDICARE: MR. JAMES C LEE LCSW

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	1041C0700X	Clinical Social Worker	5444-C	NV

General Provider Information

NPI Number	:	1487773537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES C LEE LCSW

Provider Business Mailing Address
First Line	:	6441 SOUTHERN PINE WAY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-6657
Country	:	US
Telephone Number	:	301-606-8895
Fax Number	:

Provider Business Practice Location Address
First Line	:	1980 FESTIVAL PLAZA DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89135-2927
Country	:	US
Telephone Number	:	833-419-0181
Fax Number	:

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

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	07/15/2025

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