MEDICARE: ASCENT COUNSELING AND PSYCHOLOGICAL SERVICES, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1295201200
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASCENT COUNSELING AND PSYCHOLOGICAL SERVICES, PLLC

Provider Business Mailing Address
First Line	:	5478 S 31ST ST
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49048-9365
Country	:	US
Telephone Number	:	616-286-9598
Fax Number	:

Provider Business Practice Location Address
First Line	:	5985 WEST MAIN
Second Line	:	SUITE 816
City	:	KALAMAZOO
State	:	MI
Zip	:	49009
Country	:	US
Telephone Number	:	616-286-9598
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KATHRYN JEAN LEWIS
Credential	:	PSY.D.
Telephone Number	:	616-890-3292

Provider Enumeration Date	:	10/17/2018
Last Update Date	:	10/04/2024

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