Provider Demographics
NPI:1568658623
Name:LEWIS, CHERYL (PHD, LLP)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:PHD, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38800 GARFIELD RD STE 100
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-6619
Mailing Address - Country:US
Mailing Address - Phone:586-231-0306
Mailing Address - Fax:586-231-0307
Practice Address - Street 1:38800 GARFIELD RD STE 100
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-6619
Practice Address - Country:US
Practice Address - Phone:586-231-0306
Practice Address - Fax:586-231-0307
Is Sole Proprietor?:No
Enumeration Date:2007-09-21
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301011383103T00000X
MI6301013464103T00000X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP1-0-89-1076-0OtherBC/BSM