Healthcare Provider Details

I. General information

NPI: 1730826983
Provider Name (Legal Business Name): RENEE JOANN LEE CMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2022
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5319 W ROCHDALE LN
HERRIMAN UT
84096-3601
US

IV. Provider business mailing address

5319 W ROCHDALE LN
HERRIMAN UT
84096-3601
US

V. Phone/Fax

Practice location:
  • Phone: 970-812-3283
  • Fax:
Mailing address:
  • Phone: 970-712-4109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-24280
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12857872-6004
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCC.0019217
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: