Provider Demographics
NPI:1417335084
Name:LEWIS, VERNON (MA, LPC)
Entity Type:Individual
Prefix:
First Name:VERNON
Middle Name:
Last Name:LEWIS
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10117
Mailing Address - Street 2:
Mailing Address - City:RIVER OAKS
Mailing Address - State:TX
Mailing Address - Zip Code:76114-0117
Mailing Address - Country:US
Mailing Address - Phone:817-624-1222
Mailing Address - Fax:817-460-0286
Practice Address - Street 1:920 ROBERTS CUT OFF RD
Practice Address - Street 2:STE A
Practice Address - City:RIVER OAKS
Practice Address - State:TX
Practice Address - Zip Code:76114-2826
Practice Address - Country:US
Practice Address - Phone:817-624-1222
Practice Address - Fax:817-624-1213
Is Sole Proprietor?:No
Enumeration Date:2015-05-14
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72084101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional