Provider Demographics
NPI:1376654509
Name:LEWIS, THONAS O'NEAL (LBSW,LCDC)
Entity Type:Individual
Prefix:MR
First Name:THONAS
Middle Name:O'NEAL
Last Name:LEWIS
Suffix:
Gender:M
Credentials:LBSW,LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 E LYNN CREEK DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76002-5404
Mailing Address - Country:US
Mailing Address - Phone:817-784-2544
Mailing Address - Fax:
Practice Address - Street 1:1930 W E ROBERTS DR
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-1335
Practice Address - Country:US
Practice Address - Phone:972-660-8565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10793104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker