Provider Demographics
NPI:1689169633
Name:LEWIS, BETH ANNE (LPC-INTERN)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:ANNE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LPC-INTERN
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:ANNE
Other - Last Name:CROCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1717 47TH ST # A
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79412-2217
Mailing Address - Country:US
Mailing Address - Phone:903-816-1935
Mailing Address - Fax:
Practice Address - Street 1:804 PECAN GROVE RD E
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-1767
Practice Address - Country:US
Practice Address - Phone:903-893-7768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-22
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional