MEDICARE: LEWIS FAMILY WELLNESS CENTER LLC

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	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1881289221
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEWIS FAMILY WELLNESS CENTER LLC

Provider Business Mailing Address
First Line	:	8823 ZEALAND AVE N STE H
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55445-1800
Country	:	US
Telephone Number	:	763-691-9002
Fax Number	:

Provider Business Practice Location Address
First Line	:	8823 ZEALAND AVE N STE H
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55445-1800
Country	:	US
Telephone Number	:	763-691-9002
Fax Number	:

Authorized Official
Title or Position	:	OWNER/LMFT
Name	:	CERISE DIONE LEWIS
Credential	:	MS, LMFT
Telephone Number	:	763-691-9002

Provider Enumeration Date	:	03/08/2021
Last Update Date	:	03/06/2026

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