Provider Demographics
NPI:1801380357
Name:LEWIS, KEISHA GAYE
Entity Type:Individual
Prefix:
First Name:KEISHA
Middle Name:GAYE
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 1:3474 BOSTON AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602-2970
Mailing Address - Country:US
Mailing Address - Phone:510-379-0167
Mailing Address - Fax:
Practice Address - Street 1:STE CONSULTANTS, LLC
Practice Address - Street 2:3650 MT. DIABLO BLVD., SUITE 107
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549
Practice Address - Country:US
Practice Address - Phone:510-379-0167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-19
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician