Provider Demographics
NPI:1275846412
Name:LEWIS, PATRICK JOSEPH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:JOSEPH
Last Name:LEWIS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:777 E SOUTH TEMPLE
Mailing Address - Street 2:APT 8C
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1272
Mailing Address - Country:US
Mailing Address - Phone:314-398-2351
Mailing Address - Fax:801-853-8237
Practice Address - Street 1:275 E SOUTH TEMPLE
Practice Address - Street 2:STE 150
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-1270
Practice Address - Country:US
Practice Address - Phone:314-398-2351
Practice Address - Fax:801-853-8237
Is Sole Proprietor?:No
Enumeration Date:2010-07-16
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9289374-2501103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist