Provider Demographics
NPI:1326346271
Name:LEWIS, LAUREL (LMFT)
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4453 ABBOTT AVE S
Mailing Address - Street 2:LOWER
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55410-1444
Mailing Address - Country:US
Mailing Address - Phone:612-245-2916
Mailing Address - Fax:
Practice Address - Street 1:4453 ABBOTT AVE S
Practice Address - Street 2:LOWER
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55410-1444
Practice Address - Country:US
Practice Address - Phone:612-834-1767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1258106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist