Provider Demographics
NPI:1184232605
Name:LEWIS, BESS (PSYD)
Entity type:Individual
Prefix:DR
First Name:BESS
Middle Name:
Last Name:LEWIS
Suffix:
Gender:
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 W LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-6728
Mailing Address - Country:US
Mailing Address - Phone:423-364-2972
Mailing Address - Fax:
Practice Address - Street 1:1735 W STATE FRANKLIN ROAD
Practice Address - Street 2:STE 5 #180
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-4030
Practice Address - Country:US
Practice Address - Phone:423-631-5873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-21
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
TNP0000002156103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN10011OtherPSYPACT