MEDICARE: PATRICIA LEES 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	103T00000X	Psychologist	P0000001512	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0125281	OTHER	TN	BLUE CROSS BLUE SHIELD NU

General Provider Information

NPI Number	:	1376653493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA LEES PH.D.

Provider Business Mailing Address
First Line	:	105 FOREST CT
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37919-5078
Country	:	US
Telephone Number	:	865-558-8669
Fax Number	:	865-558-8648

Provider Business Practice Location Address
First Line	:	105 FOREST CT
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37919-5078
Country	:	US
Telephone Number	:	865-558-8669
Fax Number	:	865-558-8648

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	08/16/2023

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