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General NPI Number Information
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NPI Number | 1972012391
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Entity Type | Individual
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Provider Name | LEE THAO LPCC, LADC
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Gender | Female
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Dates
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Enumeration Date | 09/28/2017
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Last Update Date | 03/17/2025
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Provider Practice Location Address
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Address Line | 2345 RICE ST STE 145
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City | ROSEVILLE
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State | MN
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Zip | 55113-3720
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Country | US
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Telephone | 612-314-3076
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Fax | 651-251-4889
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Provider Business Mailing Address
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Address Line | 1377 COUNTY ROAD E W
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City | ARDEN HILLS
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State | MN
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Zip | 55112-3654
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Country | US
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Telephone | 612-314-3076
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Fax | 79-313-1400
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 305599
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 127583
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License Number State | IA
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 11190-125
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License Number State | WI
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 3470
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License Number State | MN
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Taxonomy #5
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 3470
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License Number State | MN
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