Provider Demographics
NPI:1619372828
Name:LEWING, CHAD (PHD)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:LEWING
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 WILLAMETTE PL
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-5115
Mailing Address - Country:US
Mailing Address - Phone:719-330-9110
Mailing Address - Fax:719-466-2021
Practice Address - Street 1:3010 WILLAMETTE PL
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-5115
Practice Address - Country:US
Practice Address - Phone:719-330-9110
Practice Address - Fax:719-466-2021
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-30
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3395103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical