Provider Demographics
NPI:1275645665
Name:LEWIS, DEBRA K (PSYD LP)
Entity type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:K
Last Name:LEWIS
Suffix:
Gender:F
Credentials:PSYD LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 E LONG LAKE RD STE 314
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-4738
Mailing Address - Country:US
Mailing Address - Phone:248-202-3779
Mailing Address - Fax:
Practice Address - Street 1:55 E LONG LAKE RD STE 314
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-4738
Practice Address - Country:US
Practice Address - Phone:248-202-3779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIC-00012101YA0400X
MI63010103394103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI1179Medicare PIN