Healthcare Provider Details

I. General information

NPI: 1710609110
Provider Name (Legal Business Name): LOREN L LEE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2022
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16655 W BLUEMOUND RD STE 301
BROOKFIELD WI
53005-5935
US

IV. Provider business mailing address

16535 W BLUEMOUND RD STE 200
BROOKFIELD WI
53005-5906
US

V. Phone/Fax

Practice location:
  • Phone: 414-301-3091
  • Fax:
Mailing address:
  • Phone: 262-999-3495
  • Fax: 262-821-6180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number10007-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: