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General NPI Number Information
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NPI Number | 1477815827
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Entity Type | Individual
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Provider Name | GLENELL M LEE PH.D.
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Gender | Female
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Dates
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Enumeration Date | 06/12/2012
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Last Update Date | 06/12/2012
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Provider Practice Location Address
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Address Line | 1656 E UNION ST
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City | GREENVILLE
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State | MS
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Zip | 38703-3250
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Country | US
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Telephone | 662-332-5360
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Fax | 662-332-5363
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Provider Business Mailing Address
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Address Line | 1656 E UNION ST
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City | GREENVILLE
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State | MS
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Zip | 38703-3250
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Country | US
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Telephone | 662-332-5360
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Fax | 662-332-5363
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | C1291
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License Number State | MS
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