Provider Demographics
NPI:1851599955
Name:LEWIS, JOLI MICHELLE (LPC, LADAC)
Entity Type:Individual
Prefix:
First Name:JOLI
Middle Name:MICHELLE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LPC, LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1060
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:AR
Mailing Address - Zip Code:72650-1060
Mailing Address - Country:US
Mailing Address - Phone:870-448-5733
Mailing Address - Fax:
Practice Address - Street 1:465 MEDICAL CENTER PARKWAY
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:AR
Practice Address - Zip Code:72031-1529
Practice Address - Country:US
Practice Address - Phone:501-745-7888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019004811101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE