Provider Demographics
NPI:1275319311
Name:KELLUM LEWIS, MARRIAGE & FAMILY THERAPIST, INC.
Entity Type:Organization
Organization Name:KELLUM LEWIS, MARRIAGE & FAMILY THERAPIST, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:KELLUM
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:626-765-1753
Mailing Address - Street 1:44 EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-4339
Mailing Address - Country:US
Mailing Address - Phone:626-765-1753
Mailing Address - Fax:
Practice Address - Street 1:95 N MARENGO AVE STE 205
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-1755
Practice Address - Country:US
Practice Address - Phone:626-765-1753
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty