Provider Demographics
NPI:1609149848
Name:LEWIS, KATHYRN (LPC, CSAC, ICS)
Entity type:Individual
Prefix:
First Name:KATHYRN
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LPC, CSAC, ICS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:386 EAGLE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:PELICAN LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54463-9414
Mailing Address - Country:US
Mailing Address - Phone:608-213-3885
Mailing Address - Fax:
Practice Address - Street 1:4155 COUNTY H
Practice Address - Street 2:
Practice Address - City:LAONA
Practice Address - State:WI
Practice Address - Zip Code:54541-9293
Practice Address - Country:US
Practice Address - Phone:715-674-7656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-20
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)