Healthcare Provider Details

I. General information

NPI: 1699119941
Provider Name (Legal Business Name): LEZLEE HENRY-DUPOUX LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2013
Last Update Date: 03/05/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 E 82ND AVE STE 103
ANCHORAGE AK
99518-3100
US

IV. Provider business mailing address

PMB #566 1120 HUFFMAN RD STE 24
ANCHORAGE AK
99515-3516
US

V. Phone/Fax

Practice location:
  • Phone: 907-215-8153
  • Fax:
Mailing address:
  • Phone: 907-215-8153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number106272
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW61170290
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0799121
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number079912
License Number StateNY
# 6
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number100520
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: