Provider Demographics
NPI:1033682133
Name:LEWIS, LYNNCHETTA LATONISH
Entity Type:Individual
Prefix:
First Name:LYNNCHETTA
Middle Name:LATONISH
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 1:430 PERROTTI ST
Mailing Address - Street 2:
Mailing Address - City:EUNICE
Mailing Address - State:LA
Mailing Address - Zip Code:70535-6104
Mailing Address - Country:US
Mailing Address - Phone:337-580-8067
Mailing Address - Fax:
Practice Address - Street 1:805 S UNION ST
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-6029
Practice Address - Country:US
Practice Address - Phone:337-678-4004
Practice Address - Fax:337-678-3777
Is Sole Proprietor?:No
Enumeration Date:2019-01-10
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106E00000X, 171M00000X
LA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst