Provider Demographics
NPI:1700593472
Name:LEWIS, REEVE III (RAC, PSS)
Entity Type:Individual
Prefix:
First Name:REEVE
Middle Name:
Last Name:LEWIS
Suffix:III
Gender:M
Credentials:RAC, PSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 CIVIC CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-5937
Mailing Address - Country:US
Mailing Address - Phone:985-333-2020
Mailing Address - Fax:
Practice Address - Street 1:235 CIVIC CENTER BLVD
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-5937
Practice Address - Country:US
Practice Address - Phone:985-333-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-02
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
LA1558101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1558OtherREGISTERED ADDICTION COUNSELOR
LAOBHPSS1048OtherLOUISIANA OFFICE OF BEHAVIORAL HEALTH - PEER SUPPORT SPECIALIST