Provider Demographics
NPI:1225403132
Name:LEWIS, KENTRELL JAMON
Entity Type:Individual
Prefix:
First Name:KENTRELL
Middle Name:JAMON
Last Name:LEWIS
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 1:620 5TH ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:LA
Mailing Address - Zip Code:70538-5602
Mailing Address - Country:US
Mailing Address - Phone:337-380-1089
Mailing Address - Fax:
Practice Address - Street 1:620 5TH ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:LA
Practice Address - Zip Code:70538-5602
Practice Address - Country:US
Practice Address - Phone:337-380-1089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-03
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor