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NPI Code Detail

MEDICARE: WYKEETA MICHELE LEE M.A. LPC

MEDICARE: WYKEETA MICHELE LEE M.A. LPC
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
1101YP2500XProfessional Counselor2010038927MO

General Provider Information

NPI Number : 1376718544
Entity Type Code : Individual
Provider Name (Legal Business Name) : WYKEETA MICHELE LEE M.A. LPC
Provider Business Mailing Address
First Line : 9666 OLIVE
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63132-2342
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 9666 OLIVE BLVD
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63132-3013
Country : US
Telephone Number : 314-325-2906
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/28/2008
Last Update Date : 09/01/2016

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