Provider Demographics
NPI:1821658626
Name:LEWIS, SHAKARI (LPC)
Entity Type:Individual
Prefix:
First Name:SHAKARI
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5225 N IRONWOOD RD STE 117
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-4909
Mailing Address - Country:US
Mailing Address - Phone:414-502-9355
Mailing Address - Fax:
Practice Address - Street 1:5205 N IRONWOOD RD STE 117
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53217-4907
Practice Address - Country:US
Practice Address - Phone:414-502-9355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-14
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6866-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional