Provider Demographics
NPI:1255499471
Name:LEWIS, DAVID ISRAEL (LPC LMFT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ISRAEL
Last Name:LEWIS
Suffix:
Gender:M
Credentials:LPC LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1591
Mailing Address - Street 2:
Mailing Address - City:SULPHUR SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:75483-1591
Mailing Address - Country:US
Mailing Address - Phone:903-885-2273
Mailing Address - Fax:469-375-5375
Practice Address - Street 1:410 COUNTY ROAD 3640
Practice Address - Street 2:
Practice Address - City:SULPHUR SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75482-6913
Practice Address - Country:US
Practice Address - Phone:903-885-2273
Practice Address - Fax:469-375-5375
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
TX19719101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX151974602Medicaid