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Individual

GARY W LEE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LCSW

Contact information

Practice address
1965 S EAGLE RD, STE 140, MERIDIAN, ID 83642-9288
(208) 957-6514
(208) 957-6506
Mailing address
1965 S EAGLE RD, STE 140, MERIDIAN, ID 83642-9288
(208) 957-6514
(208) 957-6506

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW578
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000010015750
REGENCE BLUE SHIELD OF ID
ID
01
077063
VALUE OPTIONS
NY
01
L9982
BLUE CROSS OF IDAHO
ID
Enumeration date
01/04/2007
Last updated
08/05/2016
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