Provider Demographics
NPI:1376215657
Name:LEWIS, ELEXUS S (LPC-ASSOCIATE)
Entity Type:Individual
Prefix:
First Name:ELEXUS
Middle Name:S
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LPC-ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2713 GAINS MILL DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76123-2213
Mailing Address - Country:US
Mailing Address - Phone:682-557-6766
Mailing Address - Fax:
Practice Address - Street 1:3603 W PIONEER PKWY STE A
Practice Address - Street 2:
Practice Address - City:PANTEGO
Practice Address - State:TX
Practice Address - Zip Code:76013-4535
Practice Address - Country:US
Practice Address - Phone:817-801-3414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX85421101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional