Provider Demographics
NPI:1669971644
Name:LEWIS, COURTNIE
Entity type:Individual
Prefix:
First Name:COURTNIE
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MATTERS OF THE HEART
Other - Middle Name:
Other - Last Name:FAMILY SUPPORT SERVICES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PEER SPECIALIST
Mailing Address - Street 1:5718 HIGHLAND HILLS DR APT 144
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75241-4059
Mailing Address - Country:US
Mailing Address - Phone:337-677-4467
Mailing Address - Fax:
Practice Address - Street 1:5718 HIGHLAND HILLS DR APT 144
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75241-4059
Practice Address - Country:US
Practice Address - Phone:337-476-1719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-06
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer Specialist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No172V00000XOther Service ProvidersCommunity Health Worker
No174400000XOther Service ProvidersSpecialist
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response AttendantGroup - Single Specialty
No171400000XOther Service ProvidersHealth & Wellness Coach
No171W00000XOther Service ProvidersContractor
No372600000XNursing Service Related ProvidersAdult Companion
No174N00000XOther Service ProvidersLactation Consultant, Non-RN
No374J00000XNursing Service Related ProvidersDoula
No251K00000XAgenciesPublic Health or Welfare
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1669971114OtherNPI