Healthcare Provider Details

I. General information

NPI: 1841700606
Provider Name (Legal Business Name): JESSICA LEWIS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JESSICA ROBINSON

II. Dates (important events)

Enumeration Date: 10/06/2017
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15700 W 10 MILE RD STE 115
SOUTHFIELD MI
48075-2100
US

IV. Provider business mailing address

15700 W 10 MILE RD STE 115
SOUTHFIELD MI
48075-2100
US

V. Phone/Fax

Practice location:
  • Phone: 313-355-4543
  • Fax:
Mailing address:
  • Phone: 313-355-4543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401020335
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.1902252
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401020335
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: