Individual
KEVIN P. LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
L.M.S.W.
Contact information
Practice address
540 3RD ST, IDAHO FALLS, ID 83401-3953
(208) 529-3702
Mailing address
540 3RD ST, IDAHO FALLS, ID 83401-3953
(208) 529-3702
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LMSW-25561
ID
Other
Enumeration date
01/19/2009
Last updated
01/19/2009
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