| Doctor Name: | LEWIS ELLIS |
| NPI Number: | 1013023431 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 6301011250 |
| Business Practice Address: | 1722 Shaffer St Kalamazoo, MI - 490481633 |
| Business Phone Number: | 2692265600 |
| Business Fax Number: | |
| Mailing Address: | 5943 Stadium Dr, Suite 3 KALAMAZOO |
| State: | MI |
| Postal Code: | 490093016 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 08/21/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 6301011250 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | MI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |