Individual
JASON LEWIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LLP
Contact information
Practice address
496 W ANN ARBOR TRL, PLYMOUTH, MI 48170-6262
(248) 930-0090
Mailing address
1030 WOODBOURNE ST, WESTLAND, MI 48186-5320
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301012208
MI
Other
Enumeration date
12/16/2014
Last updated
12/16/2014
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