Healthcare Provider Details

I. General information

NPI: 1528381589
Provider Name (Legal Business Name): MS. L'OREAL LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2010
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6132 NEWPORT AVE
SAINT LOUIS MO
63116-2925
US

IV. Provider business mailing address

1428 ORCHARD LAKES CIR
BELLEVILLE IL
62220-4915
US

V. Phone/Fax

Practice location:
  • Phone: 618-509-0001
  • Fax:
Mailing address:
  • Phone: 618-509-0001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: