Provider Demographics
NPI:1033469465
Name:LEWIS, MICHAEL STEPHEN (BA)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:STEPHEN
Last Name:LEWIS
Suffix:
Gender:M
Credentials:BA
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Mailing Address - Street 1:650 S PEORIA
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74129-4429
Mailing Address - Country:US
Mailing Address - Phone:918-587-9471
Mailing Address - Fax:918-560-1399
Practice Address - Street 1:102 N DENVER
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74103
Practice Address - Country:US
Practice Address - Phone:918-582-1200
Practice Address - Fax:918-560-1399
Is Sole Proprietor?:No
Enumeration Date:2012-09-13
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst