Individual
JOHN LEE
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Contact information
Practice address
101 W KIRKWOOD AVE, STE 213, BLOOMINGTON, IN 47404-6129
(812) 332-9200
Mailing address
101 W KIRKWOOD AVE, STE 213, BLOOMINGTON, IN 47404-6129
(812) 332-9200
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
39001314A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000275434
ANTHEM
IN
Enumeration date
02/13/2006
Last updated
07/08/2007
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