Provider Demographics
NPI:1407256746
Name:BANK, LEWIS (PHD, PSYCHOLOGIST)
Entity Type:Individual
Prefix:
First Name:LEWIS
Middle Name:
Last Name:BANK
Suffix:
Gender:M
Credentials:PHD, PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 NW WALL ST STE 303
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-1970
Mailing Address - Country:US
Mailing Address - Phone:503-367-4042
Mailing Address - Fax:844-269-6806
Practice Address - Street 1:1345 NW WALL ST STE 303
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-1970
Practice Address - Country:US
Practice Address - Phone:503-367-4042
Practice Address - Fax:844-269-6806
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-22
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR605101YM0800X, 103G00000X, 103K00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty