Healthcare Provider Details

I. General information

NPI: 1790561520
Provider Name (Legal Business Name): CHERYL LEE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2023
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 GUADALUPE ST STE 260
AUSTIN TX
78705-5654
US

IV. Provider business mailing address

PO BOX 20121
WACO TX
76702-0121
US

V. Phone/Fax

Practice location:
  • Phone: 254-362-7040
  • Fax:
Mailing address:
  • Phone: 254-362-7040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number106751
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: