Healthcare Provider Details

I. General information

NPI: 1598815565
Provider Name (Legal Business Name): MICHAEL P LEWIS MA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 10/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 GABBARDTOWN RD
BEREA KY
40403-9278
US

IV. Provider business mailing address

1351 NEWTOWN PIKE
LEXINGTON KY
40511-1217
US

V. Phone/Fax

Practice location:
  • Phone: 859-253-1686
  • Fax: 859-254-2743
Mailing address:
  • Phone: 859-253-1686
  • Fax: 859-254-2743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1487
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: