MEDICARE: NICHOLAS LEWIS

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	101YM0800X	Mental Health Counselor
2	101Y00000X	Counselor	BBHPCLCLIC74443	MT

General Provider Information

NPI Number	:	1770307068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS LEWIS

Provider Business Mailing Address
First Line	:	2717 RAYMOND AVE
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59802-3215
Country	:	US
Telephone Number	:	760-305-3526
Fax Number	:

Provider Business Practice Location Address
First Line	:	2717 RAYMOND AVE
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59802-3215
Country	:	US
Telephone Number	:	760-305-3526
Fax Number	:

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

Provider Enumeration Date	:	11/13/2024
Last Update Date	:	01/13/2026

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Directions to “ NICHOLAS LEWIS ” Practice Location

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