MEDICARE: LEE CENTER FOR CHANGE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	1041C0700X	Clinical Social Worker
2	261QM0855X	Adolescent and Children Mental Health Clinic/Center
3	103T00000X	Psychologist
4	261QM1300X	Multi-Specialty Clinic/Center
5	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1871087908
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEE CENTER FOR CHANGE

Provider Business Mailing Address
First Line	:	6771 DRAGONFLY ROCK ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-4310
Country	:	US
Telephone Number	:	702-218-8815
Fax Number	:

Provider Business Practice Location Address
First Line	:	3075 E FLAMINGO RD STE 118
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-4300
Country	:	US
Telephone Number	:	702-218-8815
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MORGAN LEE
Credential	:
Telephone Number	:	702-218-8815

Provider Enumeration Date	:	06/21/2018
Last Update Date	:	06/21/2018

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Directions to “LEE CENTER FOR CHANGE ” Practice Location

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