Provider Demographics
NPI:1225180730
Name:LEWIS, ROBERT JAMES (MA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JAMES
Last Name:LEWIS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:BOB
Other - Middle Name:
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2264 MCGILCHRIST ST SE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-1187
Mailing Address - Country:US
Mailing Address - Phone:503-581-7700
Mailing Address - Fax:503-581-7799
Practice Address - Street 1:2264 MCGILCHRIST ST SE
Practice Address - Street 2:SUITE 100
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-1187
Practice Address - Country:US
Practice Address - Phone:503-581-7700
Practice Address - Fax:503-581-7799
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT0434106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist