Provider Demographics
NPI:1649681990
Name:LEWIS, MARCIA (AMFT #72446)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:AMFT #72446
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1730 W OLYMPIC BLVD # 3A-300
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-1019
Mailing Address - Country:US
Mailing Address - Phone:213-249-9388
Mailing Address - Fax:213-389-7993
Practice Address - Street 1:44359 PALM ST
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-3116
Practice Address - Country:US
Practice Address - Phone:760-342-6616
Practice Address - Fax:760-347-8276
Is Sole Proprietor?:No
Enumeration Date:2014-05-08
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA72446106H00000X
CAC18491214101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist