Provider Demographics
NPI:1659124402
Name:LEWIS, MARY MELISSA (MMFT)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:MELISSA
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 BATTLEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37069-6453
Mailing Address - Country:US
Mailing Address - Phone:615-210-7724
Mailing Address - Fax:
Practice Address - Street 1:1107 BATTLEWOOD ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37069-6453
Practice Address - Country:US
Practice Address - Phone:615-210-7724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-10
Last Update Date:2024-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty