Provider Demographics
NPI:1467995266
Name:LEWIS, AUDRA MARIE (MFT)
Entity Type:Individual
Prefix:MS
First Name:AUDRA
Middle Name:MARIE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8781 CREEKSIDE WAY APT 1036
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-1583
Mailing Address - Country:US
Mailing Address - Phone:209-201-2840
Mailing Address - Fax:
Practice Address - Street 1:1658 YORK ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-1410
Practice Address - Country:US
Practice Address - Phone:303-935-5307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-28
Last Update Date:2020-09-24
Deactivation Date:2020-09-09
Deactivation Code:
Reactivation Date:2020-09-16
Provider Licenses
StateLicense IDTaxonomies
CO0001821106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist