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General NPI Number Information
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NPI Number | 1770701633
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Entity Type | Individual
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Provider Name | JILL COLETTE LEWIS M.A. LAC, GUIDANCE
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Gender | Female
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 11/16/2009
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Provider Practice Location Address
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Address Line | 8176 NORTH WESTOVER
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City | JOSEPH CITY
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State | AZ
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Zip | 86032
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Country | US
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Telephone | 928-288-3307
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Fax | 928-288-3309
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Provider Business Mailing Address
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Address Line | P.O. BOX 2500
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City | SNOWFLAKE
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State | AZ
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Zip | 85937
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Country | US
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Telephone | 928-243-1441
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LAC-11268
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 101YS0200X
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Taxonomy Name | School Counselor
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License Number | 2331144
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License Number State | AZ
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