Healthcare Provider Details

I. General information

NPI: 1093633042
Provider Name (Legal Business Name): CHRISTINE LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17359 EDISON AVE
CHESTERFIELD MO
63005-1250
US

IV. Provider business mailing address

601 PARKER DR
BALLWIN MO
63021-4820
US

V. Phone/Fax

Practice location:
  • Phone: 636-547-1577
  • Fax:
Mailing address:
  • Phone: 314-728-8181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number2026030094
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: