Healthcare Provider Details

I. General information

NPI: 1568386209
Provider Name (Legal Business Name): JEREMY EUGENE LEE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61262 WATSON RD
ST IGNATIUS MT
59865-9124
US

IV. Provider business mailing address

61262 WATSON RD
ST IGNATIUS MT
59865-9124
US

V. Phone/Fax

Practice location:
  • Phone: 406-747-0375
  • Fax:
Mailing address:
  • Phone: 406-747-0375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberBBH-ACLC-LIC-88973
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: