Provider Demographics
NPI:1245756956
Name:ROCKY J. LEWIS MFT
Entity Type:Organization
Organization Name:ROCKY J. LEWIS MFT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROCKY
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT / LPCC
Authorized Official - Phone:818-577-9751
Mailing Address - Street 1:22231 MULHOLLAND HWY STE 200
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-5173
Mailing Address - Country:US
Mailing Address - Phone:818-577-9751
Mailing Address - Fax:818-337-2286
Practice Address - Street 1:22231 MULHOLLAND HWY STE 200
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-5173
Practice Address - Country:US
Practice Address - Phone:818-577-9751
Practice Address - Fax:818-337-2286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC45808261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)