Provider Demographics
NPI:1093605040
Name:LEWIS, ALYSSA BRIANNA
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:BRIANNA
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 1:120 MIMOSA DR
Mailing Address - Street 2:
Mailing Address - City:GRENADA
Mailing Address - State:MS
Mailing Address - Zip Code:38901-4814
Mailing Address - Country:US
Mailing Address - Phone:662-417-9760
Mailing Address - Fax:
Practice Address - Street 1:515 SIMPSON DR
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MS
Practice Address - Zip Code:38967-3009
Practice Address - Country:US
Practice Address - Phone:662-283-2801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-09
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician