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General NPI Number Information
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NPI Number | 1659576817
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Entity Type | Individual
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Provider Name | CHARLES LEE DEPRIEST P.C.
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Gender | Male
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Dates
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Enumeration Date | 06/18/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 975 S SUNBURY RD
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City | WESTERVILLE
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State | OH
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Zip | 43081-9345
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Country | US
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Telephone | 614-865-0513
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Fax |
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Provider Business Mailing Address
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Address Line | 441 SHERWOOD DR W
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City | NEWARK
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State | OH
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Zip | 43055-4465
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Country | US
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Telephone | 740-345-7484
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Fax |
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | C70007091
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License Number State | OH
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