Provider Demographics
NPI:1346732856
Name:LEWIS, RACHEAL (LPC)
Entity Type:Individual
Prefix:MRS
First Name:RACHEAL
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:RACHEAL
Other - Middle Name:
Other - Last Name:MATTIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:2110 OAK PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-7864
Mailing Address - Country:US
Mailing Address - Phone:337-475-0324
Mailing Address - Fax:
Practice Address - Street 1:2110 OAK PARK BLVD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-7864
Practice Address - Country:US
Practice Address - Phone:337-475-0324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-31
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5984101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAQSJZ02117768OtherBLUE CROSS BLUESHIELD