Healthcare Provider Details

I. General information

NPI: 1952885337
Provider Name (Legal Business Name): LAUREN RAMSEY LEWIS MS, R-DMT, LPC-IT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2018
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4570 S 27TH ST
MILWAUKEE WI
53221-2145
US

IV. Provider business mailing address

PO BOX 778789
CHICAGO IL
60677-8789
US

V. Phone/Fax

Practice location:
  • Phone: 414-897-5511
  • Fax:
Mailing address:
  • Phone: 414-672-1353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8354-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: