Provider Demographics
NPI:1225175912
Name:LEWIS, ALAN DANA (MS, PSYD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:DANA
Last Name:LEWIS
Suffix:
Gender:M
Credentials:MS, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44012 N 44TH LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85087-5930
Mailing Address - Country:US
Mailing Address - Phone:602-318-0328
Mailing Address - Fax:
Practice Address - Street 1:1830 E ROOSEVELT ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-3641
Practice Address - Country:US
Practice Address - Phone:602-318-0328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3404103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical