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General NPI Number Information
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NPI Number | 1699254433
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Entity Type | Organization
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Legal Business Name | STEPHANIE LEE LLC
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Dates
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Enumeration Date | 08/13/2018
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Last Update Date | 08/13/2018
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Provider Practice Location Address
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Address Line | 4660 MARSH RD STE G-1
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City | OKEMOS
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State | MI
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Zip | 48864-2143
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Country | US
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Telephone | 517-525-3836
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Fax |
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Provider Business Mailing Address
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Address Line | 4660 MARSH RD STE G-1
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City | OKEMOS
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State | MI
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Zip | 48864-2143
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | STEPHANIE LEE
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Credential | LMSW
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Telephone | 517-525-3836
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801090410
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License Number State | MI
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