Provider Demographics
NPI:1851998199
Name:LEWIS, CANDACE NICOLE (LPC)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:NICOLE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 S SARA RD
Mailing Address - Street 2:
Mailing Address - City:MUSTANG
Mailing Address - State:OK
Mailing Address - Zip Code:73064-4311
Mailing Address - Country:US
Mailing Address - Phone:405-266-6846
Mailing Address - Fax:405-281-3422
Practice Address - Street 1:301 S SARA RD
Practice Address - Street 2:
Practice Address - City:MUSTANG
Practice Address - State:OK
Practice Address - Zip Code:73064-4311
Practice Address - Country:US
Practice Address - Phone:405-266-6846
Practice Address - Fax:405-281-3422
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-08
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11268101YM0800X
OK101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health