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General NPI Number Information
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NPI Number | 1679347017
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Entity Type | Individual
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Provider Name | TASHA L LEWIS MA, LPCC, LPC
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Gender | Female
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Dates
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Enumeration Date | 11/07/2023
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Last Update Date | 10/07/2024
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Provider Practice Location Address
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Address Line | 5315 WALL ST
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City | MADISON
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State | WI
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Zip | 53718-7937
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Country | US
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Telephone | 507-535-5703
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Fax |
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Provider Business Mailing Address
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Address Line | 5315 WALL ST STE 290
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City | MADISON
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State | WI
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Zip | 53718-7965
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Country | US
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Telephone |
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Fax |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 4116
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 11054-125
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License Number State | WI
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