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NPI Code Detail

MEDICARE: KELLYE JEAN LEWIS MA, LPC, NCC

MEDICARE: KELLYE JEAN LEWIS MA, LPC, NCC
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
1101YP2500XProfessional CounselorLPC6093LA

General Provider Information

NPI Number : 1952815458
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLYE JEAN LEWIS MA, LPC, NCC
Provider Business Mailing Address
First Line : 108 COLIN P KELLY DR
Second Line :
City : MINDEN
State : LA
Zip : 71055-7912
Country : US
Telephone Number : 318-402-6379
Fax Number :
Provider Business Practice Location Address
First Line : 3821 SOUTHERN AVE
Second Line :
City : SHREVEPORT
State : LA
Zip : 71106-1033
Country : US
Telephone Number : 318-946-8157
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/21/2017
Last Update Date : 11/21/2017

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