MEDICARE: LOREN LEE 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
1	101YM0800X	Mental Health Counselor	10007-125	WI
2	101Y00000X	Counselor	10007-125	WI
3	101YP2500X	Professional Counselor	10007-125	WI

General Provider Information

NPI Number	:	1710609110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOREN LEE LPC

Provider Business Mailing Address
First Line	:	305 PLEASANT ST
Second Line	:
City	:	EAGLE
State	:	WI
Zip	:	53119-2235
Country	:	US
Telephone Number	:	501-941-9238
Fax Number	:

Provider Business Practice Location Address
First Line	:	16655 W BLUEMOUND RD STE 301
Second Line	:
City	:	BROOKFIELD
State	:	WI
Zip	:	53005-5935
Country	:	US
Telephone Number	:	414-301-3091
Fax Number	:

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

Provider Enumeration Date	:	09/13/2022
Last Update Date	:	08/15/2023

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