Provider Demographics
NPI:1952481301
Name:LEWIS-ZYGIEL, MARY JANE (MED, LPC, LCDC)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:JANE
Last Name:LEWIS-ZYGIEL
Suffix:
Gender:F
Credentials:MED, LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1512 SCRIPTURE ST
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-3916
Mailing Address - Country:US
Mailing Address - Phone:940-382-5328
Mailing Address - Fax:940-898-8527
Practice Address - Street 1:1512 SCRIPTURE ST
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-3916
Practice Address - Country:US
Practice Address - Phone:940-382-5328
Practice Address - Fax:940-898-8527
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3669101YA0400X
TX12395101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10029875OtherAMERIGROUP PROVIDER NUMBE
TX85012LOtherBCBS PROVIDER NUMBER