Provider Demographics
NPI:1265581458
Name:OKUN, LEWIS EDWARD (PHD)
Entity type:Individual
Prefix:DR
First Name:LEWIS
Middle Name:EDWARD
Last Name:OKUN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 S HURON PKWY STE 3A
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-5133
Mailing Address - Country:US
Mailing Address - Phone:734-223-1248
Mailing Address - Fax:888-403-0285
Practice Address - Street 1:2301 S HURON PKWY STE 3A
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-5133
Practice Address - Country:US
Practice Address - Phone:734-223-1248
Practice Address - Fax:888-403-0285
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301002860103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI620N112940OtherBLUE CROSS BLUE SHIELD
MI0N31200Medicare PIN