MEDICARE: MRS. MELINDA MARIE LEE LPC

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	101YP2500X	Professional Counselor	3656	CO

General Provider Information

NPI Number	:	1144439654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MELINDA MARIE LEE LPC

Provider Business Mailing Address
First Line	:	420 S LOOMIS AVE
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80521-2545
Country	:	US
Telephone Number	:	970-416-1480
Fax Number	:	970-416-1483

Provider Business Practice Location Address
First Line	:	420 S LOOMIS AVE
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80521-2545
Country	:	US
Telephone Number	:	970-416-1480
Fax Number	:	970-416-1483

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

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	07/08/2007

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