Provider Demographics
NPI:1740447770
Name:LEWIS, KELLY LORA (PHD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:LORA
Last Name:LEWIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:KELLY
Other - Middle Name:LORA
Other - Last Name:HORRIGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:TOPEKA VA MEDICAL CTR
Mailing Address - Street 2:2200 SW GAGE BLVD
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66622-0001
Mailing Address - Country:US
Mailing Address - Phone:785-350-3111
Mailing Address - Fax:
Practice Address - Street 1:TOPEKA VA MEDICAL CTR
Practice Address - Street 2:2200 SW GAGE BLVD
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66622-0001
Practice Address - Country:US
Practice Address - Phone:785-350-3111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006034117103T00000X
KS1768103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist