Provider Demographics
NPI:1891832077
Name:LEWIS, JAY (MS)
Entity Type:Individual
Prefix:MR
First Name:JAY
Middle Name:
Last Name:LEWIS
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3523 MCKINNEY AVE
Mailing Address - Street 2:#481
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-1401
Mailing Address - Country:US
Mailing Address - Phone:214-207-5903
Mailing Address - Fax:
Practice Address - Street 1:3710 RAWLINS ST
Practice Address - Street 2:SUITE 1370
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-4217
Practice Address - Country:US
Practice Address - Phone:214-207-5903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14434101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional