Healthcare Provider Details

I. General information

NPI: 1851599955
Provider Name (Legal Business Name): JOLI MICHELLE LEWIS LPC, LADAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 MEDICAL CENTER PARKWAY
CLINTON AR
72031-1529
US

IV. Provider business mailing address

PO BOX 1060
MARSHALL AR
72650-1060
US

V. Phone/Fax

Practice location:
  • Phone: 501-745-7888
  • Fax:
Mailing address:
  • Phone: 870-448-5733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP2102157
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2019004811
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: