Provider Demographics
NPI:1790368272
Name:LEWIS, STEPHON JORDAN (LPC)
Entity type:Individual
Prefix:
First Name:STEPHON
Middle Name:JORDAN
Last Name:LEWIS
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 E WEBER DR UNIT 1001
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85288-0916
Mailing Address - Country:US
Mailing Address - Phone:816-522-4458
Mailing Address - Fax:
Practice Address - Street 1:8700 E VIA DE VENTURA STE 280
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4541
Practice Address - Country:US
Practice Address - Phone:816-522-4458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-03
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021015291101YP2500X
AZLPC-23657101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2021015291Medicaid