Provider Demographics
NPI:1457533457
Name:LEWIS, KRISTIN (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3950 3RD ST N
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-4033
Mailing Address - Country:US
Mailing Address - Phone:320-253-5930
Mailing Address - Fax:320-258-4632
Practice Address - Street 1:3950 3RD ST N
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-4033
Practice Address - Country:US
Practice Address - Phone:320-253-5930
Practice Address - Fax:320-258-4632
Is Sole Proprietor?:No
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1766106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist