NPI 1003454190

Samantha Brooke Lee

Practitioner Behavior Technician Bloomington, IN

Practice location

Address: 1501 W Tapp Rd, Bloomington, IN 47403-3459
Phone: (812) 330-4460
Fax: (812) 330-4461

Registered specialties

Behavior Technician Primary

Behavioral Health & Social Service Providers Taxonomy 106S00000X Licence RBT-19-90479 (IN)

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Registry record

NPI: 1003454190
Entity type: Individual
Sex (as registered): Female
NPI issued: 19 Dec 2019
Record last updated: 19 Dec 2019

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.