Provider Demographics
NPI:1598953077
Name:BADGER, LEWLYN FRANCIS (LPC)
Entity Type:Individual
Prefix:
First Name:LEWLYN
Middle Name:FRANCIS
Last Name:BADGER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 N CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75801-7606
Mailing Address - Country:US
Mailing Address - Phone:903-948-6799
Mailing Address - Fax:903-729-7781
Practice Address - Street 1:1011 S SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-5041
Practice Address - Country:US
Practice Address - Phone:903-948-6799
Practice Address - Fax:903-729-7781
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63332101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00T09ZMedicaid
TX1447388939Medicaid
TX1538297023Medicaid
TX187594001OtherTPI
TX1710015201Medicaid
TX1710015201Medicare UPIN