Provider Demographics
NPI:1508004524
Name:LEWIS, ANGIE H
Entity type:Individual
Prefix:
First Name:ANGIE
Middle Name:H
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1941 NE PETERS DR
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-5388
Mailing Address - Country:US
Mailing Address - Phone:816-332-7913
Mailing Address - Fax:
Practice Address - Street 1:1260 NE WINDSOR DR
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-5594
Practice Address - Country:US
Practice Address - Phone:816-347-8777
Practice Address - Fax:816-347-8541
Is Sole Proprietor?:No
Enumeration Date:2009-01-29
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1854101YA0400X
MO20110278371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)