Individual
KELLEN LEWIS SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6202 CONSTITUTION DR, FORT WAYNE, IN 46804-1583
(260) 515-0522
Mailing address
9712 SERPENTINE CV, FORT WAYNE, IN 46804-5238
(260) 515-0522
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
88001951A
IN
Other
Enumeration date
06/07/2023
Last updated
06/07/2023
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