MEDICARE: JENNIFER LEE COUNSELING PLLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1326555681
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JENNIFER LEE COUNSELING PLLC

Provider Business Mailing Address
First Line	:	1311 CHISHOLM TRL STE 102
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78681-2969
Country	:	US
Telephone Number	:	512-970-4995
Fax Number	:

Provider Business Practice Location Address
First Line	:	1311 CHISHOLM TRL STE 102
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78681-2969
Country	:	US
Telephone Number	:	512-677-5625
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	JENNIFER LEE
Credential	:
Telephone Number	:	512-970-4995

Provider Enumeration Date	:	01/08/2018
Last Update Date	:	06/11/2019

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