Provider Demographics
NPI:1750855748
Name:LEWINSON, THEAVIA LEIGH (MS)
Entity type:Individual
Prefix:
First Name:THEAVIA
Middle Name:LEIGH
Last Name:LEWINSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12655 CROSSROADS PARK DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-3375
Mailing Address - Country:US
Mailing Address - Phone:786-395-4508
Mailing Address - Fax:
Practice Address - Street 1:9610 HUFFMEISTER RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-2895
Practice Address - Country:US
Practice Address - Phone:612-702-6068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-14
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-18-48892106S00000X
TX1-22-60893103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician