Provider Demographics
NPI:1275996456
Name:LEWIS, MYRON
Entity Type:Individual
Prefix:
First Name:MYRON
Middle Name:
Last Name:LEWIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 OVERWOOD RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-5362
Mailing Address - Country:US
Mailing Address - Phone:330-607-2906
Mailing Address - Fax:330-375-2401
Practice Address - Street 1:550 OVERWOOD RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44313-5362
Practice Address - Country:US
Practice Address - Phone:330-607-2906
Practice Address - Fax:330-375-2401
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-04
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH011353101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)