Healthcare Provider Details

I. General information

NPI: 1760808521
Provider Name (Legal Business Name): NANCY LEWIS DMFT, LMFT, LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NANCY KEMP, HISLOP

II. Dates (important events)

Enumeration Date: 03/17/2014
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 6TH ST SE
WILLMAR MN
56201-4675
US

IV. Provider business mailing address

1125 6TH ST SE
WILLMAR MN
56201-4675
US

V. Phone/Fax

Practice location:
  • Phone: 320-235-4613
  • Fax: 855-625-7406
Mailing address:
  • Phone: 320-235-4613
  • Fax: 855-625-7406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number302257
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number3493
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number3493
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: