Provider Demographics
NPI:1720454598
Name:LEWIS, JAMIE ANNE (PHD)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:ANNE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5424 W US HIGHWAY 290 SERVICE ROAD
Mailing Address - Street 2:SUITE 204-2
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735
Mailing Address - Country:US
Mailing Address - Phone:206-999-7740
Mailing Address - Fax:
Practice Address - Street 1:5424 W US HIGHWAY 290 SERVICE ROAD
Practice Address - Street 2:SUITE 204-2
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735
Practice Address - Country:US
Practice Address - Phone:206-999-7740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-17
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39044103TC0700X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical