=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225152143
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LEE COUNSELING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/17/2007
-----------------------------------------------------
Last Update Date | 06/16/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1661 HARDSCRABBLE RD
-----------------------------------------------------
City | MUNSON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16860-9404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-345-6236
-----------------------------------------------------
Fax | 814-345-6230
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1661 HARDSCRABBLE RD
-----------------------------------------------------
City | MUNSON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16860-9404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-345-6236
-----------------------------------------------------
Fax | 814-345-6230
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | GENERAL PARTNER
-----------------------------------------------------
Name | MR. REESE A. LEE
-----------------------------------------------------
Credential | CAC, LPC
-----------------------------------------------------
Telephone | 814-345-6236
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | PC001825
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------