Provider Demographics
NPI:1003359134
Name:LEWIS, SHANISE
Entity Type:Individual
Prefix:MS
First Name:SHANISE
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1322 E SHAW AVE STE 260
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-7914
Mailing Address - Country:US
Mailing Address - Phone:559-349-0641
Mailing Address - Fax:
Practice Address - Street 1:1322 E SHAW AVE STE 260
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-7914
Practice Address - Country:US
Practice Address - Phone:559-349-0641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-21
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist