Provider Demographics
NPI:1629591136
Name:LEWIS, ALISSA THEO (LMFT)
Entity type:Individual
Prefix:
First Name:ALISSA
Middle Name:THEO
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:ALISSA
Other - Middle Name:THEO
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:3621 SPRUCE KEY LN
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-6115
Mailing Address - Country:US
Mailing Address - Phone:617-639-7912
Mailing Address - Fax:
Practice Address - Street 1:3621 SPRUCE KEY LN
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-6115
Practice Address - Country:US
Practice Address - Phone:617-639-7912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-18
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMF6559106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist