Provider Demographics
NPI:1457721979
Name:LEWALLEN, DAVID (PSYD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:LEWALLEN
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 1:190 SE 8TH AVE # 181
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4216
Mailing Address - Country:US
Mailing Address - Phone:503-352-7333
Mailing Address - Fax:
Practice Address - Street 1:21900 WILLAMETTE DR STE 202
Practice Address - Street 2:
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-3284
Practice Address - Country:US
Practice Address - Phone:503-653-0631
Practice Address - Fax:503-653-1464
Is Sole Proprietor?:No
Enumeration Date:2015-09-26
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health