Lee Todd Lacks, LCPC-C, MT-BC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

XL3782 Issued in ME

Practice address

9 Lemont Ave
South Portland, ME 04106-5717

Phone

(207) 210-6045

NPI assigned

Oct 6, 2011

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1317859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1317859200000",
    "number": "1285918383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 LEMONT AVE",
            "city": "SOUTH PORTLAND",
            "state": "ME",
            "postal_code": "041065717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9 LEMONT AVE",
            "city": "SOUTH PORTLAND",
            "state": "ME",
            "postal_code": "041065717",
            "telephone_number": "207-210-6045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LACKS",
        "first_name": "LEE",
        "middle_name": "TODD",
        "name_prefix": "Mr.",
        "credential": "LCPC-C, MT-BC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-10-06",
        "last_updated": "2011-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "ME",
            "license": "XL3782",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "ME",
            "license": "XL3782",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community/Behavioral Health Agency in South Portland, ME
• Providers in South Portland, ME by specialty
• Community/Behavioral Health Agency in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.