Healthcare Provider Details

I. General information

NPI: 1134570666
Provider Name (Legal Business Name): TERRY LEWIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2016
Last Update Date: 06/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20288 HIGHWAY 15 N STE 100
HUTCHINSON MN
55350-5685
US

IV. Provider business mailing address

20288 HIGHWAY 15 N STE 100
HUTCHINSON MN
55350-5685
US

V. Phone/Fax

Practice location:
  • Phone: 320-587-2326
  • Fax: 320-234-6358
Mailing address:
  • Phone: 320-587-2326
  • Fax: 320-234-6358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: