MEDICARE: MRS. CHERL LYNN LEE

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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1952831109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHERL LYNN LEE

Provider Business Mailing Address
First Line	:	3703 24TH ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48208-2415
Country	:	US
Telephone Number	:	313-580-8481
Fax Number	:

Provider Business Practice Location Address
First Line	:	9 PINE CONE DR STE 107
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32137-8683
Country	:	US
Telephone Number	:	313-316-3679
Fax Number	:

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

Provider Enumeration Date	:	06/19/2017
Last Update Date	:	01/08/2024

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