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General NPI Number Information
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NPI Number | 1578943080
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Entity Type | Individual
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Provider Name | MARGARET MARY LEWIS
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Gender | Female
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Dates
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Enumeration Date | 06/01/2015
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Last Update Date | 06/08/2015
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Provider Practice Location Address
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Address Line | 3701 12TH STREET SUITE 203
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City | SAINT CLOUD
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State | MN
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Zip | 56303
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Country | US
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Telephone | 218-631-5993
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Fax | 218-631-7043
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Provider Business Mailing Address
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Address Line | 1900 SILVER LAKE RD NW 110
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City | NEW BRIGHTON
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State | MN
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Zip | 55112-1786
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Country | US
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Telephone | 651-379-1718
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Fax | 651-628-0411
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 1667
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License Number State | MN
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