Provider Demographics
NPI:1013768787
Name:LEWIS, TERRANCE RAYMOND
Entity Type:Individual
Prefix:
First Name:TERRANCE
Middle Name:RAYMOND
Last Name:LEWIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1403 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:MARTINS FERRY
Mailing Address - State:OH
Mailing Address - Zip Code:43935-1884
Mailing Address - Country:US
Mailing Address - Phone:304-639-9809
Mailing Address - Fax:740-738-0707
Practice Address - Street 1:1403 N 6TH ST
Practice Address - Street 2:
Practice Address - City:MARTINS FERRY
Practice Address - State:OH
Practice Address - Zip Code:43935-1884
Practice Address - Country:US
Practice Address - Phone:304-639-9809
Practice Address - Fax:740-738-0707
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-29
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health