Provider Demographics
NPI:1003904038
Name:LEWIS, ZEN JORDAN (PHD, LMHC, LPCC)
Entity Type:Individual
Prefix:DR
First Name:ZEN
Middle Name:JORDAN
Last Name:LEWIS
Suffix:
Gender:M
Credentials:PHD, LMHC, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:398 CAMINO GARDENS BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-5827
Mailing Address - Country:US
Mailing Address - Phone:954-399-2093
Mailing Address - Fax:561-620-2972
Practice Address - Street 1:213 W ALAMEDA AVE STE 103
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-3027
Practice Address - Country:US
Practice Address - Phone:833-333-7936
Practice Address - Fax:561-620-2972
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH-9760101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health