MEDICARE: COURTNEY C. LEE PSYCHOTHERAPY 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1437701539
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COURTNEY C. LEE PSYCHOTHERAPY LLC

Provider Business Mailing Address
First Line	:	1010 MARQUEZ PL STE D11
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-1724
Country	:	US
Telephone Number	:	505-699-3538
Fax Number	:

Provider Business Practice Location Address
First Line	:	1010 MARQUEZ PL STE D11
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-1724
Country	:	US
Telephone Number	:	505-699-3538
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	COURTNEY COLLINS LEE
Credential	:	LPCC
Telephone Number	:	505-633-3538

Provider Enumeration Date	:	07/10/2019
Last Update Date	:	11/20/2019

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