Provider Demographics
NPI:1790248789
Name:LEWIS, TEONNA PATRICE
Entity Type:Individual
Prefix:
First Name:TEONNA
Middle Name:PATRICE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13192 ASHVIEW DR
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-7434
Mailing Address - Country:US
Mailing Address - Phone:812-239-9640
Mailing Address - Fax:
Practice Address - Street 1:1106 MERIDIAN ST STE 215
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46016-1761
Practice Address - Country:US
Practice Address - Phone:317-874-6336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-08
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health