1861427551 NPI number — LEA ANNE LEWIS LCPC

Table of content: LEA ANNE LEWIS LCPC (NPI 1861427551)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861427551 NPI number — LEA ANNE LEWIS LCPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEWIS
Provider First Name:
LEA
Provider Middle Name:
ANNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861427551
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
924 AVENUE E NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREAT FALLS
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59404-1742
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-788-8006
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 INDIANA
Provider Second Line Business Practice Location Address:
CENTER FOR MENTAL HEALTH
Provider Business Practice Location Address City Name:
CHINOOK
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59523
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-357-3364
Provider Business Practice Location Address Fax Number:
406-357-2934
Provider Enumeration Date:
07/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  1036 LCPC , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0000745433 . This is a "BLUE CROSS/SHIELD OF MONT" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".




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