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General NPI Number Information
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NPI Number | 1720639255
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Entity Type | Individual
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Provider Name | VIVIAN LEE
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Gender | Female
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Dates
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Enumeration Date | 09/25/2019
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Last Update Date | 09/24/2021
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Provider Practice Location Address
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Address Line | 14800 LANDMARK BLVD
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City | DALLAS
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State | TX
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Zip | 75254-7565
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Country | US
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Telephone | 214-238-9956
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Fax |
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Provider Business Mailing Address
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Address Line | 2401 OHIO DR APT 1008
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City | PLANO
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State | TX
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Zip | 75093-3975
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Country | US
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Telephone | 512-426-1693
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 15208
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 85030
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License Number State | TX
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