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General NPI Number Information
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NPI Number | 1396086005
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Entity Type | Individual
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Provider Name | KELLY ANN LEWIS LLBSW
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Gender | Female
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Dates
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Enumeration Date | 03/05/2013
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Last Update Date | 06/11/2015
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Provider Practice Location Address
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Address Line | 1800 W BIG BEAVER RD SUITE 150
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City | TROY
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State | MI
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Zip | 48084-3545
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Country | US
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Telephone | 248-918-5600
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Fax | 248-918-5600
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Provider Business Mailing Address
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Address Line | 1800 WEST BIG BEAVER ROAD SUITE 150
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City | TROY
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State | MI
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Zip | 48084
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Country | US
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Telephone | 248-918-5600
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Fax | 248-530-3096
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | 6802087604
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6802087604
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License Number State | MI
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