Healthcare Provider Details

I. General information

NPI: 1861427551
Provider Name (Legal Business Name): LEA ANNE LEWIS LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 INDIANA CENTER FOR MENTAL HEALTH
CHINOOK MT
59523
US

IV. Provider business mailing address

924 AVENUE E NW
GREAT FALLS MT
59404-1742
US

V. Phone/Fax

Practice location:
  • Phone: 406-357-3364
  • Fax: 406-357-2934
Mailing address:
  • Phone: 406-788-8006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1036 LCPC
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: