MEDICARE: MARY ELIZABETH LEE

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	2025004074	MO
2	1041C0700X	Clinical Social Worker	51521	TX

General Provider Information

NPI Number	:	1174328207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ELIZABETH LEE

Provider Business Mailing Address
First Line	:	400 W 49TH TER APT 2038
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64112-2532
Country	:	US
Telephone Number	:	713-906-7851
Fax Number	:	713-906-7851

Provider Business Practice Location Address
First Line	:	400 W 49TH TER APT 2038
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64112-2532
Country	:	US
Telephone Number	:	713-906-7851
Fax Number	:	713-906-7851

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

Provider Enumeration Date	:	02/13/2025
Last Update Date	:	02/13/2025

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Directions to “ MARY ELIZABETH LEE ” Practice Location

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