Provider Demographics
NPI:1255865580
Name:LEWIS, ALESHIA
Entity Type:Individual
Prefix:
First Name:ALESHIA
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 LOUISIANA ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:LA
Mailing Address - Zip Code:71052-2621
Mailing Address - Country:US
Mailing Address - Phone:318-872-2085
Mailing Address - Fax:318-872-2082
Practice Address - Street 1:501 LOUISIANA ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:LA
Practice Address - Zip Code:71052-2621
Practice Address - Country:US
Practice Address - Phone:318-872-2085
Practice Address - Fax:318-872-2082
Is Sole Proprietor?:No
Enumeration Date:2017-04-13
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA522089886Medicaid