Provider Demographics
NPI:1477832186
Name:LEWIS, JUSTIN PAUL (MA)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:PAUL
Last Name:LEWIS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2820 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-4170
Mailing Address - Country:US
Mailing Address - Phone:270-442-5738
Mailing Address - Fax:270-442-3172
Practice Address - Street 1:2820 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-4170
Practice Address - Country:US
Practice Address - Phone:270-442-5738
Practice Address - Fax:270-442-3172
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY09-030106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist