Provider Demographics
NPI:1568712420
Name:LEWIS, LAURA JEAN (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:JEAN
Last Name:LEWIS
Suffix:
Gender:F
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 1:1000 HIGH ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-4044
Mailing Address - Country:US
Mailing Address - Phone:614-505-6874
Mailing Address - Fax:614-505-6876
Practice Address - Street 1:1000 HIGH ST
Practice Address - Street 2:SUITE D
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-4044
Practice Address - Country:US
Practice Address - Phone:614-505-6874
Practice Address - Fax:614-505-6876
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC1000102101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health