MEDICARE: MIKAYLA M LEWIS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number
1	171M00000X	Case Manager/Care Coordinator
2	172V00000X	Community Health Worker
3	101YM0800X	Mental Health Counselor	MC61560400

General Provider Information

NPI Number	:	1710468335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIKAYLA M LEWIS

Provider Business Mailing Address
First Line	:	3965 SE BETHEL RD
Second Line	:	SUITE 1 #120
City	:	PORT ORCHARD
State	:	WA
Zip	:	98366
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2497 BETHEL RD SE STE 201
Second Line	:
City	:	PORT ORCHARD
State	:	WA
Zip	:	98366-2489
Country	:	US
Telephone Number	:	360-979-6047
Fax Number	:

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

Provider Enumeration Date	:	08/22/2018
Last Update Date	:	06/10/2024

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Directions to “ MIKAYLA M LEWIS ” Practice Location

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