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General NPI Number Information
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NPI Number | 1669396859
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Entity Type | Organization
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Legal Business Name | SAMANTHA LEWIS
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Dates
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Enumeration Date | 08/10/2026
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Last Update Date | 08/10/2026
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Provider Practice Location Address
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Address Line | 4550 S QUINCY AVE
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City | MILWAUKEE
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State | WI
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Zip | 53207-5223
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Country | US
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Telephone | 414-216-3428
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Fax |
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Provider Business Mailing Address
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Address Line | 4550 S QUINCY AVE
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City | MILWAUKEE
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State | WI
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Zip | 53207-5223
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Country | US
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Telephone | 414-216-3428
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SAMANTHA L LEWIS
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Credential | LPC-IT
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Telephone | 414-216-3428
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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