Provider Demographics
NPI:1871779447
Name:LEWIS, JUDY ANN (MA, LPC)
Entity type:Individual
Prefix:MS
First Name:JUDY
Middle Name:ANN
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 KARL GREIMEL DR
Mailing Address - Street 2:SUITE 100 C
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-9465
Mailing Address - Country:US
Mailing Address - Phone:810-844-2588
Mailing Address - Fax:810-225-8702
Practice Address - Street 1:1021 KARL GREIMEL DR
Practice Address - Street 2:SUITE 100 C
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-9465
Practice Address - Country:US
Practice Address - Phone:810-844-2588
Practice Address - Fax:810-225-8702
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401008956101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health