Healthcare Provider Details

I. General information

NPI: 1356535975
Provider Name (Legal Business Name): WENDY BRUMLEY LEE LCSW, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2007
Last Update Date: 05/11/2023
Certification Date: 05/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1644 S. COLLEGE AVENUE
FT. COLLINS CO
80521
US

IV. Provider business mailing address

1644 S COLLEGE AVE
FORT COLLINS CO
80525-1007
US

V. Phone/Fax

Practice location:
  • Phone: 970-221-0550
  • Fax: 970-221-5402
Mailing address:
  • Phone: 970-221-0999
  • Fax: 970-221-5272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1309
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: