Active NPI
Michelle Lewis, MA, LLP
- Clinical Psychologist
- Detroit, MI
National Provider Identifier
1104114966
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 6301010219
- Practice address
- 62 W 7 Mile Rd
Detroit, MI 48203-1967 - Phone
- (313) 893-6172
- Fax
- (313) 893-0064
- NPI assigned
- Jul 14, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 6301010219 | MI | Primary |
Addresses
Primary practice location
62 W 7 Mile Rd
Detroit, MI 48203-1967
Mailing address
19758 Patton St
Detroit, MI 48219-2052
Phone (313) 244-4141
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3434247 | Medicaid | MI |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | pcerecords.acc@direct.mihin.net | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6301010219 | MI | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1310601600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1634774400000",
"number": "1104114966",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19758 PATTON ST",
"city": "DETROIT",
"state": "MI",
"postal_code": "482192052",
"telephone_number": "313-244-4141"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "62 W 7 MILE RD",
"city": "DETROIT",
"state": "MI",
"postal_code": "482031967",
"telephone_number": "313-893-6172",
"fax_number": "313-893-0064"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEWIS",
"first_name": "MICHELLE",
"name_prefix": "Mrs.",
"credential": "MA, LLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-07-14",
"last_updated": "2021-10-21",
"certification_date": "2021-10-21",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MI",
"license": "6301010219",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3434247",
"state": "MI"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "pcerecords.acc@direct.mihin.net",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"address_1": "62 W 7 Mile Rd",
"city": "Detroit",
"state": "MI",
"country_code": "US",
"postal_code": "482031967",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.