Provider Demographics
NPI:1306375225
Name:LEWIS, DAVENA ELAYNE (LMFT)
Entity Type:Individual
Prefix:
First Name:DAVENA
Middle Name:ELAYNE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6291 CAMBRIDGE WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-7905
Mailing Address - Country:US
Mailing Address - Phone:317-718-8436
Mailing Address - Fax:
Practice Address - Street 1:202 MYERS RD
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IN
Practice Address - Zip Code:46122-9702
Practice Address - Country:US
Practice Address - Phone:317-718-8436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-05
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35002122A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist