Provider Demographics
NPI:1851829402
Name:LEWIS, JASON LEE (MA, MMFT)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:LEE
Last Name:LEWIS
Suffix:
Gender:M
Credentials:MA, MMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2496 WILDCAT RD
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:TN
Mailing Address - Zip Code:38583-6588
Mailing Address - Country:US
Mailing Address - Phone:931-252-3786
Mailing Address - Fax:
Practice Address - Street 1:410 E SPRING ST STE E
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-3791
Practice Address - Country:US
Practice Address - Phone:931-372-1308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-26
Last Update Date:2017-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health