Healthcare Provider Details

I. General information

NPI: 1134626229
Provider Name (Legal Business Name): JEAN LEWIS CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2018
Last Update Date: 04/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

#5 INDIAN HILLS ESTATES
ENCAMPMENT WY
82325-0163
US

IV. Provider business mailing address

P. O. BOX 163
ENCAMPMENT WY
82325-0163
US

V. Phone/Fax

Practice location:
  • Phone: 307-710-6684
  • Fax:
Mailing address:
  • Phone: 307-710-6684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-057
License Number StateWY

VIII. Authorized Official

Name: MS. M JEAN LEWIS
Title or Position: OWNER
Credential: LPC
Phone: 307-710-6684