MEDICARE: MICHAEL S LEE LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LCSW24210	ID

General Provider Information

NPI Number	:	1083707277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL S LEE LCSW

Provider Business Mailing Address
First Line	:	2007 S PLAZA
Second Line	:	SUITE #1
City	:	EMMETT
State	:	ID
Zip	:	83617
Country	:	US
Telephone Number	:	208-365-5445
Fax Number	:	208-365-6226

Provider Business Practice Location Address
First Line	:	2007 S PLAZA
Second Line	:	SUITE #1
City	:	EMMETT
State	:	ID
Zip	:	83617
Country	:	US
Telephone Number	:	208-365-5445
Fax Number	:	208-365-6226

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	03/08/2026

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