Provider Demographics
NPI:1750420535
Name:LEWIS, YOLANDA FAYE (LMFT)
Entity type:Individual
Prefix:MRS
First Name:YOLANDA
Middle Name:FAYE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:YOLANDA
Other - Middle Name:FAYE
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4743 MAYTIME LN
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-5069
Mailing Address - Country:US
Mailing Address - Phone:323-481-6612
Mailing Address - Fax:
Practice Address - Street 1:3875 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90062-1105
Practice Address - Country:US
Practice Address - Phone:323-290-4357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35627106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist