Provider Demographics
NPI:1396086005
Name:LEWIS, KELLY ANN (LLBSW)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:ANN
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LLBSW
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:ANN
Other - Last Name:JESSOP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1800 WEST BIG BEAVER ROAD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084
Mailing Address - Country:US
Mailing Address - Phone:248-918-5600
Mailing Address - Fax:248-530-3096
Practice Address - Street 1:1800 W BIG BEAVER RD
Practice Address - Street 2:SUITE 150
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-3545
Practice Address - Country:US
Practice Address - Phone:248-918-5600
Practice Address - Fax:248-918-5600
Is Sole Proprietor?:No
Enumeration Date:2013-03-05
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802087604171M00000X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker