Healthcare Provider Details

I. General information

NPI: 1972043545
Provider Name (Legal Business Name): ANGELA M LEE ED. D, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2017
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 ASPEN AVE
LUBBOCK TX
79404-1211
US

IV. Provider business mailing address

5506 GRINNELL ST
LUBBOCK TX
79416-1118
US

V. Phone/Fax

Practice location:
  • Phone: 806-252-0911
  • Fax: 972-984-9565
Mailing address:
  • Phone: 972-984-9565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number75256
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number75256
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC012049
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC012049
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number75256
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: