Provider Demographics
NPI:1043533052
Name:LEE, MALINDA (LCPC)
Entity type:Individual
Prefix:MS
First Name:MALINDA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:MS
Other - First Name:MALINDA
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC
Mailing Address - Street 1:3062 E 91ST ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-4401
Mailing Address - Country:US
Mailing Address - Phone:773-371-2941
Mailing Address - Fax:773-371-2950
Practice Address - Street 1:3062 E 91ST ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-4401
Practice Address - Country:US
Practice Address - Phone:773-371-2941
Practice Address - Fax:773-371-2950
Is Sole Proprietor?:No
Enumeration Date:2010-03-04
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180004773101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional