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NPI Code Detail

MEDICARE: MARCUS J LEE B.A., BHRS

MEDICARE: MARCUS J LEE B.A., BHRS
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1730199142
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARCUS J LEE B.A., BHRS
Provider Business Mailing Address
First Line : 1932 NW 172ND ST
Second Line :
City : EDMOND
State : OK
Zip : 73003-7039
Country : US
Telephone Number : 405-844-6164
Fax Number :
Provider Business Practice Location Address
First Line : 4400 N LINCOLN BLVD
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73105-5104
Country : US
Telephone Number : 405-424-7711
Fax Number : 405-425-0441
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2006
Last Update Date : 07/08/2007

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