Healthcare Provider Details

I. General information

NPI: 1841915972
Provider Name (Legal Business Name): SAMANTHA RAE LEE-HODGES PH.D., LP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2022
Last Update Date: 10/11/2022
Certification Date: 10/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 28TH ST
DENVER CO
80205-3003
US

IV. Provider business mailing address

601 N BROADWAY # MC1926
DENVER CO
80203-3407
US

V. Phone/Fax

Practice location:
  • Phone: 303-602-6333
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3919-57
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY.0005787
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: