Provider Demographics
NPI:1811576606
Name:LEWIS, KAITLYN (MA, MED, LPC)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MA, MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:JARRELL
Mailing Address - State:TX
Mailing Address - Zip Code:76537-1240
Mailing Address - Country:US
Mailing Address - Phone:508-951-2063
Mailing Address - Fax:
Practice Address - Street 1:501 N 3RD ST
Practice Address - Street 2:
Practice Address - City:JARRELL
Practice Address - State:TX
Practice Address - Zip Code:76537-1240
Practice Address - Country:US
Practice Address - Phone:508-951-2063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-07
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX82494101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional