| Mary Lee Foundation | |
|
1336 Lamar Square Dr Suite A Austin TX 78704-2214 | |
| (512) 442-6077 | |
| (512) 442-6825 |
| Full Name | Mary Lee Foundation |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1336 Lamar Square Dr, Austin, Texas |
| Authorized Official Name and Position | Don Lilljedahl (DIRECTOR OF FOUNATION) |
| Authorized Official Contact | 5124435777 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mary Lee Foundation Po Box 3174 Austin TX 78764-3174 Ph: (512) 443-5777 | Mary Lee Foundation 1336 Lamar Square Dr Suite A Austin TX 78704-2214 Ph: (512) 442-6077 |
| NPI Number | 1063614022 |
|---|---|
| Provider Enumeration Date | 06/01/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063614022 | NPI | - | NPPES |
| 23346482 993 | Other | TX | PRS CONTRACT |
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