Provider Demographics
NPI:1821460668
Name:LEWIS, CHRISTEN (RSW)
Entity Type:Individual
Prefix:
First Name:CHRISTEN
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:RSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11616 SOUTHFORK AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-5241
Mailing Address - Country:US
Mailing Address - Phone:225-291-9718
Mailing Address - Fax:225-291-9692
Practice Address - Street 1:4348 S JEFFREY DR STE 102
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-4196
Practice Address - Country:US
Practice Address - Phone:225-369-0219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-20
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9513104100000X, 171M00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA6004720433Medicaid
LA600751961Medicaid