MEDICARE: MRS. JILL COLETTE LEWIS M.A. LAC, GUIDANCE

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	101Y00000X	Counselor	LAC-11268	AZ
2	101YS0200X	School Counselor	2331144	AZ

General Provider Information

NPI Number	:	1770701633
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JILL COLETTE LEWIS M.A. LAC, GUIDANCE

Provider Business Mailing Address
First Line	:	P.O. BOX 2500
Second Line	:
City	:	SNOWFLAKE
State	:	AZ
Zip	:	85937
Country	:	US
Telephone Number	:	928-243-1441
Fax Number	:

Provider Business Practice Location Address
First Line	:	8176 NORTH WESTOVER
Second Line	:
City	:	JOSEPH CITY
State	:	AZ
Zip	:	86032
Country	:	US
Telephone Number	:	928-288-3307
Fax Number	:	928-288-3309

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

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	11/16/2009

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