MEDICARE: DR. LEE F LOOK PH.D.

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	101YM0800X	Mental Health Counselor	2009-24	KY

General Provider Information

NPI Number	:	1255565974
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEE F LOOK PH.D.

Provider Business Mailing Address
First Line	:	206 EXCHANGE AVE
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40207-2711
Country	:	US
Telephone Number	:	502-744-7662
Fax Number	:

Provider Business Practice Location Address
First Line	:	206 EXCHANGE AVE
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40207-2711
Country	:	US
Telephone Number	:	502-744-7662
Fax Number	:

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

Provider Enumeration Date	:	05/09/2009
Last Update Date	:	05/09/2009

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