Healthcare Provider Details

I. General information

NPI: 1902757115
Provider Name (Legal Business Name): KAYLEE CAMPOS LEWIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2026
Last Update Date: 02/04/2026
Certification Date: 02/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17100 E SHEA BLVD STE 600
FOUNTAIN HILLS AZ
85268-6663
US

IV. Provider business mailing address

10341 W SUMULLEN ST
MARANA AZ
85653-1535
US

V. Phone/Fax

Practice location:
  • Phone: 480-837-4565
  • Fax:
Mailing address:
  • Phone: 661-941-1755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: