Provider Demographics
NPI:1588024186
Name:LEWIS, SHIRLEY (CADCII, BS)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:CADCII, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 WATER AVE NW STE 100
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-2271
Mailing Address - Country:US
Mailing Address - Phone:541-512-4477
Mailing Address - Fax:
Practice Address - Street 1:10763 SW GREENBURG RD STE 100
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-5492
Practice Address - Country:US
Practice Address - Phone:503-684-8159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-25
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR19-P-12101YA0400X
OR19-QMHA-R-0018101YM0800X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health