Provider Demographics
NPI:1346672144
Name:LEWIS, GREGORY JR
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:LEWIS
Suffix:JR
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 1:2520 NW 39TH SUITE 100
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA
Mailing Address - State:OK
Mailing Address - Zip Code:73112
Mailing Address - Country:US
Mailing Address - Phone:405-889-6822
Mailing Address - Fax:
Practice Address - Street 1:2520 NW 39TH EXPY STE 100
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-3759
Practice Address - Country:US
Practice Address - Phone:405-889-6822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-02
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst