Provider Demographics
NPI:1720203995
Name:LEWIS, JAMES BAKER (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:BAKER
Last Name:LEWIS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10987 CHAPADA WAY
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-5923
Mailing Address - Country:US
Mailing Address - Phone:801-673-1447
Mailing Address - Fax:801-553-1326
Practice Address - Street 1:9500 S 500 W STE 107
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-6654
Practice Address - Country:US
Practice Address - Phone:801-673-1447
Practice Address - Fax:801-553-1326
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5207996-01601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1041C0700XOtherCLINICAL SOCIAL WORKER
UT5207996-0160OtherSTATE LICENSE