Provider Demographics
NPI:1316215072
Name:LEWIS, LEAONA (LPC)
Entity Type:Individual
Prefix:
First Name:LEAONA
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 S JEFFERSON AVE STE B
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:MO
Mailing Address - Zip Code:65536-3200
Mailing Address - Country:US
Mailing Address - Phone:706-718-1420
Mailing Address - Fax:417-319-6218
Practice Address - Street 1:301 DAVIS ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:MO
Practice Address - Zip Code:65536-2423
Practice Address - Country:US
Practice Address - Phone:706-718-1420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-09
Last Update Date:2024-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022020205101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health