Provider Demographics
NPI:1518467463
Name:LEWIS, YVONNE (MC, LPC)
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 SW 6TH AVE STE 1100
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97204-1153
Mailing Address - Country:US
Mailing Address - Phone:503-851-1910
Mailing Address - Fax:
Practice Address - Street 1:1050 SW 6TH AVE STE 1100
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97204-1153
Practice Address - Country:US
Practice Address - Phone:503-851-1910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-16
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-17151101YP2500X
ORC6127101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional