Provider Demographics
NPI:1134866858
Name:LEWIS, STEPHEN EMMANUEL (MS)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:EMMANUEL
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:PO BOX 12577
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77726-2577
Mailing Address - Country:US
Mailing Address - Phone:325-450-7487
Mailing Address - Fax:
Practice Address - Street 1:4040 CROW RD APT 502
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-7054
Practice Address - Country:US
Practice Address - Phone:325-450-7487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-14
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86807101YM0800X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health