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General NPI Number Information
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NPI Number | 1871087908
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Entity Type | Organization
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Legal Business Name | LEE CENTER FOR CHANGE
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Dates
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Enumeration Date | 06/21/2018
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Last Update Date | 06/21/2018
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Provider Practice Location Address
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Address Line | 3075 E FLAMINGO RD STE 118
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City | LAS VEGAS
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State | NV
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Zip | 89121-4300
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Country | US
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Telephone | 702-218-8815
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Fax |
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Provider Business Mailing Address
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Address Line | 6771 DRAGONFLY ROCK ST
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City | LAS VEGAS
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State | NV
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Zip | 89148-4310
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Country | US
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Telephone | 702-218-8815
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MORGAN LEE
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Credential |
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Telephone | 702-218-8815
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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