MEDICARE: JESSICA LEWIS MA, LMHC

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	MH26270	FL
2	101YM0800X	Mental Health Counselor	IMH23998	FL

General Provider Information

NPI Number	:	1962192229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA LEWIS MA, LMHC

Provider Business Mailing Address
First Line	:	1195 N STEP ST
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34286-8927
Country	:	US
Telephone Number	:	248-303-3730
Fax Number	:

Provider Business Practice Location Address
First Line	:	6210 SCOTT ST UNIT 115
Second Line	:
City	:	PUNTA GORDA
State	:	FL
Zip	:	33950-3901
Country	:	US
Telephone Number	:	941-780-4268
Fax Number	:

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

Provider Enumeration Date	:	05/10/2023
Last Update Date	:	01/05/2026

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