Provider Demographics
NPI:1598651580
Name:LEWIS, TYROME (MHPS)
Entity type:Individual
Prefix:MR
First Name:TYROME
Middle Name:
Last Name:LEWIS
Suffix:
Gender:M
Credentials:MHPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9090 SKILLMAN ST # 182A-205
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-8259
Mailing Address - Country:US
Mailing Address - Phone:972-202-6367
Mailing Address - Fax:
Practice Address - Street 1:9090 SKILLMAN ST # 182A-205
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-8259
Practice Address - Country:US
Practice Address - Phone:972-202-6367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2217-1224175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist