Provider Information for 1477690659
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Mrs. NIKKI SUE LEWIS-CLARK M.Ed, LCPC
Sex: Female
NPI: 1477690659
Last Updated: 2012-02-08
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1477690659 | ||||||||
| Enumeration Date | 2007-01-30 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 1915 12TH AVE S GREAT FALLS, MT 59405-4804 United States Phone: 406-231-2292 | Fax: | ||||||||
| Primary Practice Address | 1915 12TH AVE S GREAT FALLS, MT 59405-4804 United States Phone: 406-231-2292 | Fax: | ||||||||
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