Healthcare Provider Details

I. General information

NPI: 1629265343
Provider Name (Legal Business Name): LEE KIRBY HOTZE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2007
Last Update Date: 07/28/2022
Certification Date: 07/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 MANHATTANVILLE RD
PURCHASE NY
10577-2113
US

IV. Provider business mailing address

PO BOX 353
MADISON AL
35758-0353
US

V. Phone/Fax

Practice location:
  • Phone: --
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC03884
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: