=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932468949
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHELLE M LEE T-LPCC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/10/2012
-----------------------------------------------------
Last Update Date | 05/10/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13336 LODESTONE TRL SE
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87123-1089
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-274-3200
-----------------------------------------------------
Fax | 505-323-0036
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13336 LODESTONE TRL SE
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87123-1089
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-274-3200
-----------------------------------------------------
Fax | 505-323-0036
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | 0077591
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------