Healthcare Provider Details

I. General information

NPI: 1821559691
Provider Name (Legal Business Name): MARY LEE SHEA PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY NORA LEE B.S., M.S.

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 GREATSTONE PT FL 2
LEXINGTON KY
40504-3274
US

IV. Provider business mailing address

302 FORREST DR
LAWRENCEBURG KY
40342-1341
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-6211
  • Fax: 859-257-7706
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number295104
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: