Provider Demographics
NPI:1184458226
Name:LEWIS, TAMERA KATINA (LMSW)
Entity type:Individual
Prefix:
First Name:TAMERA
Middle Name:KATINA
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 SOUTH FWY STE 630
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76115-1409
Mailing Address - Country:US
Mailing Address - Phone:940-268-6359
Mailing Address - Fax:
Practice Address - Street 1:4200 SOUTH FWY STE 630
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76115-1409
Practice Address - Country:US
Practice Address - Phone:940-268-6359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-30
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113676104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker