Provider Demographics
NPI:1417309675
Name:LISA LEWIS
Entity Type:Organization
Organization Name:LISA LEWIS
Other - Org Name:LISA LEWIS FAMILY COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MCCONNELL
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:317-512-1098
Mailing Address - Street 1:6801 GRAY RD
Mailing Address - Street 2:A1
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-3263
Mailing Address - Country:US
Mailing Address - Phone:317-512-1098
Mailing Address - Fax:317-825-3050
Practice Address - Street 1:6801 GRAY RD
Practice Address - Street 2:A1
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-3263
Practice Address - Country:US
Practice Address - Phone:317-512-1098
Practice Address - Fax:317-825-3050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34004000A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty