Active NPI
Jeagun Lee
- Professional Counselor
- Carrollton, TX
National Provider Identifier
1659621902
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 64631
- Practice address
- 1611 N Interstate 35E
#120
Carrollton, TX 75006-3885 - Phone
- (682) 561-9826
- NPI assigned
- Sep 13, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 64631 | TX | Primary |
Addresses
Primary practice location
1611 N Interstate 35E
#120
Carrollton, TX 75006-3885
Mailing address
1309 Park Place Blvd
#807
Hurst, TX 76053-5355
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 64631 | TX | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1347494400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1347494400000",
"number": "1659621902",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1309 PARK PLACE BLVD",
"address_2": "#807",
"city": "HURST",
"state": "TX",
"postal_code": "760535355"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1611 N INTERSTATE 35E",
"address_2": "#120",
"city": "CARROLLTON",
"state": "TX",
"postal_code": "750063885",
"telephone_number": "682-561-9826"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "JEAGUN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-09-13",
"last_updated": "2012-09-13",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "TX",
"license": "64631",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Carrollton, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.