Provider Demographics
NPI:1942785357
Name:LEWIS, CARL LEONARD II (LPC)
Entity Type:Individual
Prefix:MR
First Name:CARL
Middle Name:LEONARD
Last Name:LEWIS
Suffix:II
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8808 HUNTERS GLEN TRL
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76120-2808
Mailing Address - Country:US
Mailing Address - Phone:817-655-4592
Mailing Address - Fax:
Practice Address - Street 1:613 W MAIN ST STE 302
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76010-1045
Practice Address - Country:US
Practice Address - Phone:817-655-4592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-02
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX75631101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional