Provider Demographics
NPI:1073989133
Name:LYNETTE LEWIS PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:LYNETTE LEWIS PSYCHOLOGICAL SERVICES
Other - Org Name:LYNETTE LEWIS THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:206-779-6299
Mailing Address - Street 1:1202 200TH PL SE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-7749
Mailing Address - Country:US
Mailing Address - Phone:206-779-6299
Mailing Address - Fax:
Practice Address - Street 1:18500 156TH AVE NE STE 202
Practice Address - Street 2:
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-4459
Practice Address - Country:US
Practice Address - Phone:425-563-5213
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-12
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60501697103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty