Basic Information
| Provider Information | |||||||||
| NPI: | 1205221595 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEWIS | ||||||||
| FirstName: | KERRIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3686 US HIGHWAY 331 S | ||||||||
| Address2: | |||||||||
| City: | DEFUNIAK SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 324358463 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8508928045 | ||||||||
| FaxNumber: | 8508928039 | ||||||||
| Practice Location | |||||||||
| Address1: | 1221 W LAKEVIEW AVE | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325011836 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504693500 | ||||||||
| FaxNumber: | 8505951400 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2015 | ||||||||
| LastUpdateDate: | 04/29/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | MH13271 | FL | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.