MEDICARE: MRS. COURTNEY COLLINS LEE LMHC

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	101YM0800X	Mental Health Counselor	0079981	NM

General Provider Information

NPI Number	:	1568647360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. COURTNEY COLLINS LEE LMHC

Provider Business Mailing Address
First Line	:	4 CAMINO CALABASAS
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87506-2113
Country	:	US
Telephone Number	:	505-699-3538
Fax Number	:

Provider Business Practice Location Address
First Line	:	2100 YUCCA ST
Second Line	:	# G
City	:	SANTA FE
State	:	NM
Zip	:	87505-5456
Country	:	US
Telephone Number	:	505-467-2439
Fax Number	:

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

Provider Enumeration Date	:	12/31/2007
Last Update Date	:	12/31/2007

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