Provider Demographics
NPI:1982742607
Name:LEWIS, DAWN ROSE (MS, LPC)
Entity Type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:ROSE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:MS
Other - First Name:DAWN
Other - Middle Name:ROSE
Other - Last Name:FULTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:2241 FARNUM ST STE 102
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-4108
Mailing Address - Country:US
Mailing Address - Phone:307-262-3309
Mailing Address - Fax:307-333-0335
Practice Address - Street 1:2241 FARNUM ST STE 102
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-4108
Practice Address - Country:US
Practice Address - Phone:307-262-3309
Practice Address - Fax:307-333-0335
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC-1175101YP2500X, 101Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYLPC-1175OtherWYOMING MENTAL HEALTH LICENSING BOARD