1124026794 NPI number — MRS. SUSAN JOYE LEE LPC-MHSP, RPT, SUP.

Table of content: MRS. SUSAN JOYE LEE LPC-MHSP, RPT, SUP. (NPI 1124026794)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124026794 NPI number — MRS. SUSAN JOYE LEE LPC-MHSP, RPT, SUP.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEE
Provider First Name:
SUSAN
Provider Middle Name:
JOYE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPC-MHSP, RPT, SUP.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BIEDERSTADT
Provider Other First Name:
SUSAN
Provider Other Middle Name:
JOYE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1124026794
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/30/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9247 SPEERBERRY CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORDOVA
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38016-2399
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-251-4457
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6510 STAGE RD
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38134-3892
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-488-3123
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  14555 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: 2128 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 11737193 . This is a "CAQH" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4154354 . This is a "BCBS OF TN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 10043951 . This is a "AMERICAN BEHAVIORAL" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 84528L . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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