Provider Demographics
NPI:1134883390
Name:LEWIS, DESIREE A (MAPC, LPC)
Entity type:Individual
Prefix:
First Name:DESIREE
Middle Name:A
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MAPC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17534 W. RIDGEWAY
Mailing Address - Street 2:BOX 1063
Mailing Address - City:YARNELL
Mailing Address - State:AZ
Mailing Address - Zip Code:85362-1063
Mailing Address - Country:US
Mailing Address - Phone:928-273-4704
Mailing Address - Fax:
Practice Address - Street 1:6850 E MAYO BLVD UNIT 2101
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85054-5687
Practice Address - Country:US
Practice Address - Phone:928-273-4704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-25
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-19805101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional