Provider Demographics
NPI:1376074831
Name:LEWIS, JOHNNY (PSYD)
Entity type:Individual
Prefix:DR
First Name:JOHNNY
Middle Name:
Last Name:LEWIS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4228 BOXWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BALCH SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:75180-3626
Mailing Address - Country:US
Mailing Address - Phone:469-735-1170
Mailing Address - Fax:
Practice Address - Street 1:4228 BOXWOOD DR
Practice Address - Street 2:
Practice Address - City:BALCH SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75180-3626
Practice Address - Country:US
Practice Address - Phone:469-735-1170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-24
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist