Provider Demographics
NPI:1164874350
Name:LEWIS JR., VICTOR
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:
Last Name:LEWIS JR.
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 FELICIA AVE
Mailing Address - Street 2:
Mailing Address - City:TALLULAH
Mailing Address - State:LA
Mailing Address - Zip Code:71282-8203
Mailing Address - Country:US
Mailing Address - Phone:318-574-1232
Mailing Address - Fax:318-574-8646
Practice Address - Street 1:1705 FELICIA DRIVE
Practice Address - Street 2:
Practice Address - City:TALLULAH
Practice Address - State:LOUISIANA
Practice Address - Zip Code:71282
Practice Address - Country:UM
Practice Address - Phone:318-574-1232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health