Provider Demographics
NPI:1023886744
Name:LEWIS, JEREMY HEITH
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:HEITH
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 1:2000 FAIRFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-2002
Mailing Address - Country:US
Mailing Address - Phone:318-222-8511
Mailing Address - Fax:318-425-9670
Practice Address - Street 1:2000 FAIRFIELD AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-2002
Practice Address - Country:US
Practice Address - Phone:318-222-8511
Practice Address - Fax:318-425-9670
Is Sole Proprietor?:No
Enumeration Date:2023-12-12
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA171M00000X
LA5744101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator