Basic Information
| Provider Information | |||||||||
| NPI: | 1144863739 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEE | ||||||||
| FirstName: | MICHIKO | ||||||||
| MiddleName: | |||||||||
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| Credential: | BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6025 SPORTS VILLAGE RD | ||||||||
| Address2: | |||||||||
| City: | FRISCO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750333505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2146879374 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6025 SPORTS VILLAGE RD | ||||||||
| Address2: | |||||||||
| City: | FRISCO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750333505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2146879374 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2019 | ||||||||
| LastUpdateDate: | 08/03/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-22-60787 | TX | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.