Healthcare Provider Details

I. General information

NPI: 1649353467
Provider Name (Legal Business Name): J LEWIS WARREN D. MIN., L. M. H. P.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 COUNTRY CLUB RD # B4
GERING NE
69341-1765
US

IV. Provider business mailing address

1410 21ST ST
GERING NE
69341-2625
US

V. Phone/Fax

Practice location:
  • Phone: 308-635-3515
  • Fax:
Mailing address:
  • Phone: 308-436-3640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1332
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: