Provider Demographics
NPI:1063485605
Name:LEWIS, WILLIAM (PHD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:LEWIS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4155 E JEWELL AVE
Mailing Address - Street 2:SUITE 403
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-4504
Mailing Address - Country:US
Mailing Address - Phone:303-757-5552
Mailing Address - Fax:303-753-6397
Practice Address - Street 1:4155 E JEWELL AVE
Practice Address - Street 2:SUITE 403
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-4504
Practice Address - Country:US
Practice Address - Phone:303-757-5552
Practice Address - Fax:303-753-6397
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO705103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07024342Medicaid
COC95156Medicare ID - Type Unspecified