Provider Demographics
NPI:1063445815
Name:LEWIS, RENEE F (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:F
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2851
Mailing Address - Street 2:
Mailing Address - City:LAKE ARROWHEAD
Mailing Address - State:CA
Mailing Address - Zip Code:92352-2851
Mailing Address - Country:US
Mailing Address - Phone:909-336-3252
Mailing Address - Fax:909-336-3023
Practice Address - Street 1:28011 STATE HWY 189
Practice Address - Street 2:SUITE 100
Practice Address - City:LAKE ARROWHEAD
Practice Address - State:CA
Practice Address - Zip Code:92352-2851
Practice Address - Country:US
Practice Address - Phone:909-336-3252
Practice Address - Fax:909-336-3023
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 18434106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist