Provider Demographics
NPI:1659610350
Name:LEWIS, JASON JOSHUA (LPC, LMFT)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:JOSHUA
Last Name:LEWIS
Suffix:
Gender:M
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3834 HOLLAND DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78418-3068
Mailing Address - Country:US
Mailing Address - Phone:361-728-1582
Mailing Address - Fax:
Practice Address - Street 1:5262 S STAPLES ST STE 338
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4116
Practice Address - Country:US
Practice Address - Phone:361-728-1582
Practice Address - Fax:877-256-4374
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-31
Last Update Date:2024-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201696106H00000X
TX67161101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist