Provider Demographics
NPI:1215223730
Name:LEWIS, KEISHA FRINCHELL
Entity Type:Individual
Prefix:
First Name:KEISHA
Middle Name:FRINCHELL
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 1:326 W MICHAEL DR
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-3320
Mailing Address - Country:US
Mailing Address - Phone:405-474-4220
Mailing Address - Fax:405-741-4220
Practice Address - Street 1:326 W MICHAEL DR
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-3320
Practice Address - Country:US
Practice Address - Phone:405-474-4220
Practice Address - Fax:405-741-4220
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK11195OtherOKLAHOMA DEPARTNENT OF MENTAL HEALTH