Provider Demographics
NPI:1881289221
Name:LEWIS FAMILY WELLNESS CENTER LLC
Entity type:Organization
Organization Name:LEWIS FAMILY WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LMFT
Authorized Official - Prefix:
Authorized Official - First Name:CERISE
Authorized Official - Middle Name:DIONE
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LMFT
Authorized Official - Phone:763-691-9002
Mailing Address - Street 1:8525 EDINBROOK XING STE 15
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-1967
Mailing Address - Country:US
Mailing Address - Phone:763-691-9002
Mailing Address - Fax:
Practice Address - Street 1:8525 EDINBROOK XING STE 15
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443-1967
Practice Address - Country:US
Practice Address - Phone:763-691-9002
Practice Address - Fax:763-226-2390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-08
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty