Provider Demographics
NPI:1821639709
Name:LEWIS, TONIA SUE (PLPC)
Entity Type:Individual
Prefix:
First Name:TONIA
Middle Name:SUE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8746 LITTLE DEER DR
Mailing Address - Street 2:
Mailing Address - City:DITTMER
Mailing Address - State:MO
Mailing Address - Zip Code:63023-3606
Mailing Address - Country:US
Mailing Address - Phone:636-428-9510
Mailing Address - Fax:
Practice Address - Street 1:115 BRIERTON LN
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-1972
Practice Address - Country:US
Practice Address - Phone:636-931-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-02
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019037058202C00000X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical Examiner