MEDICARE: MRS. KRISTEN LEWIS LMFT

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	IMF81275	CA
2	106H00000X	Marriage & Family Therapist	101547	CA
3	106H00000X	Marriage & Family Therapist	0001706	CO

General Provider Information

NPI Number	:	1477004356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRISTEN LEWIS LMFT

Provider Business Mailing Address
First Line	:	2770 DAGNY WAY STE 210
Second Line	:
City	:	LAFAYETTE
State	:	CO
Zip	:	80026-8013
Country	:	US
Telephone Number	:	303-416-6128
Fax Number	:

Provider Business Practice Location Address
First Line	:	2770 DAGNY WAY STE 210
Second Line	:
City	:	LAFAYETTE
State	:	CO
Zip	:	80026-8013
Country	:	US
Telephone Number	:	303-416-6128
Fax Number	:

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

Provider Enumeration Date	:	10/17/2016
Last Update Date	:	05/26/2023

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