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General NPI Number Information
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NPI Number | 1063772689
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Entity Type | Organization
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Legal Business Name | LEE BARROW, LLC
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Dates
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Enumeration Date | 05/17/2012
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Last Update Date | 05/17/2012
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Provider Practice Location Address
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Address Line | 2225 E EDGEWOOD DR SUTIE 11
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City | LAKELAND
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State | FL
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Zip | 33803-3634
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Country | US
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Telephone | 863-937-9152
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Fax | 863-937-9154
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Provider Business Mailing Address
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Address Line | PO BOX 1533
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City | HIGHLAND CITY
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State | FL
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Zip | 33846-1533
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MICHELLE TULL
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Credential |
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Telephone | 863-937-9152
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH4263
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License Number State | FL
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