Provider Demographics
NPI:1346723798
Name:LEWIS, ROBERT N (CDP)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:N
Last Name:LEWIS
Suffix:
Gender:M
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 W FRANKLIN AVENUE
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:WA
Mailing Address - Zip Code:98944
Mailing Address - Country:US
Mailing Address - Phone:509-837-7700
Mailing Address - Fax:509-839-7311
Practice Address - Street 1:702 FRANKLIN
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:WA
Practice Address - Zip Code:98944
Practice Address - Country:US
Practice Address - Phone:509-837-7700
Practice Address - Fax:509-839-7311
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-12
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60267473101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)