MEDICARE: ANGELA D LEWIS PLPC

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	101YP2500X	Professional Counselor	2023021559	MO

General Provider Information

NPI Number	:	1447934278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA D LEWIS PLPC

Provider Business Mailing Address
First Line	:	PO BOX 25
Second Line	:
City	:	FREDERICKTOWN
State	:	MO
Zip	:	63645-0025
Country	:	US
Telephone Number	:	573-783-4400
Fax Number	:	573-783-4409

Provider Business Practice Location Address
First Line	:	600 SARGENT DR
Second Line	:
City	:	FREDERICKTOWN
State	:	MO
Zip	:	63645-7526
Country	:	US
Telephone Number	:	573-783-4400
Fax Number	:	573-783-4409

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2023
Last Update Date	:	06/14/2023

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Directions to “ ANGELA D LEWIS PLPC” Practice Location

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