Healthcare Provider Details

I. General information

NPI: 1245611383
Provider Name (Legal Business Name): AMY LEWIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2015
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5102 N 61ST AVE
GLENDALE AZ
85301-7312
US

IV. Provider business mailing address

5102 N 61ST AVE
GLENDALE AZ
85301-7312
US

V. Phone/Fax

Practice location:
  • Phone: 623-229-5660
  • Fax:
Mailing address:
  • Phone: 623-229-5660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number9805
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: