Provider Demographics
NPI:1053766469
Name:LEWIS, MARY JENNIFER (MA)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:JENNIFER
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7499 COUNTY ROAD 126
Mailing Address - Street 2:
Mailing Address - City:CARR
Mailing Address - State:CO
Mailing Address - Zip Code:80612-9600
Mailing Address - Country:US
Mailing Address - Phone:970-388-4755
Mailing Address - Fax:
Practice Address - Street 1:7499 COUNTY ROAD 126
Practice Address - Street 2:
Practice Address - City:CARR
Practice Address - State:CO
Practice Address - Zip Code:80612-9600
Practice Address - Country:US
Practice Address - Phone:970-388-4755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional