Provider Demographics
NPI:1053650887
Name:GERALD LEWIS INC.
Entity Type:Organization
Organization Name:GERALD LEWIS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:C
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:CNS
Authorized Official - Phone:219-743-3907
Mailing Address - Street 1:1150 EASTPORT CENTRE DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-8427
Mailing Address - Country:US
Mailing Address - Phone:219-286-3907
Mailing Address - Fax:219-286-3911
Practice Address - Street 1:3000 MURVIHILL RD
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-5960
Practice Address - Country:US
Practice Address - Phone:219-286-3907
Practice Address - Fax:219-286-3911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-14
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN70000167A364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Multi-Specialty