Provider Demographics
NPI:1457986838
Name:LEWIS, LISA D (LMSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:D
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 1:1414 GLASGOW LN
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-4685
Mailing Address - Country:US
Mailing Address - Phone:480-773-3884
Mailing Address - Fax:
Practice Address - Street 1:860 HEBRON PKWY STE 1102
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-5146
Practice Address - Country:US
Practice Address - Phone:972-878-8527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-06
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69150104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker