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General NPI Number Information
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NPI Number | 1114130119
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Entity Type | Individual
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Provider Name | WALTER LEE PHD
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Gender | Male
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Dates
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Enumeration Date | 05/07/2007
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Last Update Date | 09/16/2009
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Provider Practice Location Address
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Address Line | 311 N MARATHON WAY
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City | STAFFORD
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State | TX
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Zip | 77477-5819
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Country | US
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Telephone | 281-772-8407
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1552
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City | BELLAIRE
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State | TX
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Zip | 77402-1552
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Country | US
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Telephone | 281-772-8407
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Fax | 281-403-9316
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | S25118
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | S25118
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | S25118
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | S25118
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License Number State | TX
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