Provider Demographics
NPI:1609802693
Name:LEWIS, JEAN C (LPC)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:C
Last Name:LEWIS
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 1:928 N YORK ST
Mailing Address - Street 2:STE. 34
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74403-3123
Mailing Address - Country:US
Mailing Address - Phone:918-682-6470
Mailing Address - Fax:918-682-3459
Practice Address - Street 1:928 N YORK ST
Practice Address - Street 2:STE. 34
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-3123
Practice Address - Country:US
Practice Address - Phone:918-682-6470
Practice Address - Fax:918-682-3459
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1721101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional