Basic Information
| Provider Information | |||||||||
| NPI: | 1417272287 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCVAY | ||||||||
| FirstName: | LEE ANN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 E 5TH ST | ||||||||
| Address2: | |||||||||
| City: | FULTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 652511753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5735922623 | ||||||||
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| Practice Location | |||||||||
| Address1: | 600 E 5TH ST | ||||||||
| Address2: | |||||||||
| City: | FULTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 652511753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5735922623 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2010 | ||||||||
| LastUpdateDate: | 02/06/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 200901485 | MO | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.