MEDICARE: KAREN LEE'S PSYCHIATRIC HEALTH CARE

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	364SP0808X	Psychiatric/Mental Health Clinical Nurse Specialist

General Provider Information

NPI Number	:	1952943904
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAREN LEE'S PSYCHIATRIC HEALTH CARE

Provider Business Mailing Address
First Line	:	1980 E LOHMAN AVE STE B
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-3194
Country	:	US
Telephone Number	:	575-800-5902
Fax Number	:	575-888-4136

Provider Business Practice Location Address
First Line	:	1980 E LOHMAN AVE STE B
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-3194
Country	:	US
Telephone Number	:	575-800-5902
Fax Number	:	575-888-4136

Authorized Official
Title or Position	:	OWNER
Name	:	KAREN LORETTA LEE
Credential	:
Telephone Number	:	575-800-5902

Provider Enumeration Date	:	10/10/2019
Last Update Date	:	10/10/2019

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