Provider Demographics
NPI:1942490966
Name:LEWIS, SHANA DENISE (MS, LPC)
Entity Type:Individual
Prefix:MRS
First Name:SHANA
Middle Name:DENISE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 WOODWAY DR
Mailing Address - Street 2:SUITE 300 EAST
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77056-1884
Mailing Address - Country:US
Mailing Address - Phone:713-892-5483
Mailing Address - Fax:713-422-2494
Practice Address - Street 1:4801 WOODWAY DR
Practice Address - Street 2:SUITE 300 EAST
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77056-1884
Practice Address - Country:US
Practice Address - Phone:713-892-5483
Practice Address - Fax:713-422-2494
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-26
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19710101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX188407401Medicaid