Provider Demographics
NPI:1417104183
Name:LEWIS, ROBERT ELLIOTT (THERAPIST II)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:ELLIOTT
Last Name:LEWIS
Suffix:
Gender:M
Credentials:THERAPIST II
Other - Prefix:MR
Other - First Name:BOBBY
Other - Middle Name:ELLIOTT
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:2551 COORS BLVD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-1213
Mailing Address - Country:US
Mailing Address - Phone:505-338-3320
Mailing Address - Fax:
Practice Address - Street 1:750 MORRIS RD SE
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-5242
Practice Address - Country:US
Practice Address - Phone:505-866-2318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-25
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0138101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health