Basic Information
Provider Information
NPI: 1396830519
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LEWIS
FirstName: DEBRA
MiddleName: L
NamePrefix: DR.
NameSuffix:  
Credential: DMIN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5500 ARMSTRONG RD
Address2: BATTLE CREEK VAMC
City: BATTLE CREEK
State: MI
PostalCode: 490151014
CountryCode: US
TelephoneNumber: 2699665600
FaxNumber: 2696605008
Practice Location
Address1: 5500 ARMSTRONG RD
Address2: BATTLE CREEK VAMC
City: BATTLE CREEK
State: MI
PostalCode: 490151014
CountryCode: US
TelephoneNumber: 2699665600
FaxNumber: 2696605008
Other Information
ProviderEnumerationDate: 10/04/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YP1600X  Y Behavioral Health & Social Service ProvidersCounselorPastoral

No ID Information.


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