MEDICARE: DR KEITH LEE-INTEGRATIVE MENTAL HEALTH, LLC

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

General Provider Information

NPI Number	:	1265089338
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR KEITH LEE-INTEGRATIVE MENTAL HEALTH, LLC

Provider Business Mailing Address
First Line	:	1727 SWEENEY ST STE 103
Second Line	:
City	:	OWENSBORO
State	:	KY
Zip	:	42303-3834
Country	:	US
Telephone Number	:	270-316-3189
Fax Number	:

Provider Business Practice Location Address
First Line	:	1727 SWEENEY ST STE 103
Second Line	:
City	:	OWENSBORO
State	:	KY
Zip	:	42303-3834
Country	:	US
Telephone Number	:	270-316-3189
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JAMES LEE
Credential	:
Telephone Number	:	270-316-3189

Provider Enumeration Date	:	08/22/2019
Last Update Date	:	08/22/2019

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