Healthcare Provider Details
I. General information
NPI: 1306130166
Provider Name (Legal Business Name): STEPHANIE ROSEMARIE LEWIS LPCC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y
II. Dates (important events)
Enumeration Date: 06/08/2011
Last Update Date: 10/04/2021
Certification Date: 10/04/2021
Deactivation Date:
Reactivation Date:
III. Provider practice location address
22001 FAIRMOUNT BLVD
SHAKER HEIGHTS OH
44118
US
IV. Provider business mailing address
22001 FAIRMOUNT BLVD
SHAKER HEIGHTS OH
44118-4819
US
V. Phone/Fax
- Phone: 216-320-8386
- Fax:
- Phone: 216-320-8386
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 251B00000X |
| Taxonomy | Case Management Agency |
| License Number | E.1100027-SUPV |
| License Number State | OH |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 261QC1500X |
| Taxonomy | Community Health Clinic/Center |
| License Number | E.1100027-SUPV |
| License Number State | OH |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 261QF0050X |
| Taxonomy | Non-Surgical Family Planning Clinic/Center |
| License Number | E.1100027-SUPV |
| License Number State | OH |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 261QH0100X |
| Taxonomy | Health Service Clinic/Center |
| License Number | E.1100027-SUPV |
| License Number State | OH |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 261QM0801X |
| Taxonomy | Mental Health Clinic/Center (Including Community Mental Health Center) |
| License Number | E.1100027-SUPV |
| License Number State | OH |
| # 6 | |
| Primary Taxonomy | N |
| Taxonomy Code | 261QM0850X |
| Taxonomy | Adult Mental Health Clinic/Center |
| License Number | E.1100027-SUPV |
| License Number State | OH |
| # 7 | |
| Primary Taxonomy | N |
| Taxonomy Code | 261QM0855X |
| Taxonomy | Adolescent and Children Mental Health Clinic/Center |
| License Number | E.1100027-SUPV |
| License Number State | OH |
| # 8 | |
| Primary Taxonomy | N |
| Taxonomy Code | 261QM2500X |
| Taxonomy | Medical Specialty Clinic/Center |
| License Number | E.1100027-SUPV |
| License Number State | OH |
| # 9 | |
| Primary Taxonomy | N |
| Taxonomy Code | 101Y00000X |
| Taxonomy | Counselor |
| License Number | C.1100027-TRNE |
| License Number State | OH |
| # 10 | |
| Primary Taxonomy | N |
| Taxonomy Code | 101YA0400X |
| Taxonomy | Addiction (Substance Use Disorder) Counselor |
| License Number | E.1100027-SUPV |
| License Number State | OH |
| # 11 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207P00000X |
| Taxonomy | Emergency Medicine Physician |
| License Number | E.1100027-SUPV |
| License Number State | OH |
| # 12 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 251S00000X |
| Taxonomy | Community/Behavioral Health Agency |
| License Number | E.1100027-SUPV |
| License Number State | OH |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
