=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285398198
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NATHAN PARM LEE LMHCA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/26/2021
-----------------------------------------------------
Last Update Date | 10/26/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5402 132ND STREET CT NW
-----------------------------------------------------
City | GIG HARBOR
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98332-5004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-255-9312
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5402 132ND STREET CT NW
-----------------------------------------------------
City | GIG HARBOR
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98332-5004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-255-9312
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | MC61141002
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------