MEDICARE: CARMEN LEWIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	103T00000X	Psychologist	651211	MS

General Provider Information

NPI Number	:	1306234281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARMEN LEWIS

Provider Business Mailing Address
First Line	:	P.O. BOX 1456
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39215-1456
Country	:	US
Telephone Number	:	601-724-4474
Fax Number	:

Provider Business Practice Location Address
First Line	:	P.O. BOX 1456
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39215-1456
Country	:	US
Telephone Number	:	601-724-4474
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/31/2014
Last Update Date	:	09/08/2025

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Directions to “ CARMEN LEWIS ” Practice Location

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