Provider Demographics
NPI:1285950964
Name:LEWIS, M. JEAN (LPC, RN)
Entity type:Individual
Prefix:MS
First Name:M.
Middle Name:JEAN
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LPC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 INDIAN HILLS ESTATES
Mailing Address - Street 2:
Mailing Address - City:ENCAMPMENT
Mailing Address - State:WY
Mailing Address - Zip Code:82325-0163
Mailing Address - Country:US
Mailing Address - Phone:307-640-0769
Mailing Address - Fax:
Practice Address - Street 1:5 INDIAN HILLS ESTATES BLACKHALL MT ROAD
Practice Address - Street 2:
Practice Address - City:ENCAMPMENT
Practice Address - State:WY
Practice Address - Zip Code:82325-0163
Practice Address - Country:US
Practice Address - Phone:307-640-0769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC-057101YM0800X
WY9164163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No163W00000XNursing Service ProvidersRegistered Nurse