Provider Demographics
NPI:1497564447
Name:LEWIS, JEANNA (LAC)
Entity type:Individual
Prefix:
First Name:JEANNA
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1960 S WESTMONT DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85713-2572
Mailing Address - Country:US
Mailing Address - Phone:757-613-6553
Mailing Address - Fax:
Practice Address - Street 1:1960 S WESTMONT DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85713-2572
Practice Address - Country:US
Practice Address - Phone:757-613-6553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-04
Last Update Date:2025-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor