Provider Demographics
NPI:1447421672
Name:LEWIS & MIKKOLA COMPREHENSIVE PSYCHOLOGICAL SERVICES PLLC
Entity Type:Organization
Organization Name:LEWIS & MIKKOLA COMPREHENSIVE PSYCHOLOGICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:248-644-3200
Mailing Address - Street 1:30200 TELEGRAPH RD
Mailing Address - Street 2:SUITE #402
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4502
Mailing Address - Country:US
Mailing Address - Phone:248-644-3200
Mailing Address - Fax:248-644-3211
Practice Address - Street 1:30200 TELEGRAPH RD
Practice Address - Street 2:SUITE #402
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-4502
Practice Address - Country:US
Practice Address - Phone:248-644-3200
Practice Address - Fax:248-644-3211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-15
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301002406261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)