Organization
MARY LEE FOUNDATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DON LILLJEDAHL LSW (DIRECTOR OF FOUNATION)
(512) 443-5777
Entity
Organization
Contact information
Practice address
1336 LAMAR SQUARE DR, SUITE A, AUSTIN, TX 78704-2214
(512) 442-6077
(512) 442-6825
Mailing address
PO BOX 3174, AUSTIN, TX 78764-3174
(512) 443-5777
(512) 444-9949
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
114956
TX
251S00000X
Community/Behavioral Health Agency
Primary
115787
TX
251S00000X
Community/Behavioral Health Agency
115796
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
23346482 993
PRS CONTRACT
TX
Enumeration date
06/01/2007
Last updated
08/22/2020
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