Provider Demographics
NPI:1538106182
Name:LEWIS, THOMAS JEFFERSON SR (LPC; LMFT)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:JEFFERSON
Last Name:LEWIS
Suffix:SR
Gender:M
Credentials:LPC; LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 E JEFFERSON ST STE 240
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85034-2204
Mailing Address - Country:US
Mailing Address - Phone:602-616-4433
Mailing Address - Fax:
Practice Address - Street 1:700 E JEFFERSON ST
Practice Address - Street 2:250
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85034-2201
Practice Address - Country:US
Practice Address - Phone:602-616-4433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2019-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO564106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist