Healthcare Provider Details

I. General information

NPI: 1861990376
Provider Name (Legal Business Name): LEWIS ROBERT THOMPSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2018
Last Update Date: 01/17/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 E MOUNTAIN VIEW ST STE 100
BARSTOW CA
92311-2814
US

IV. Provider business mailing address

PO BOX 142
BARSTOW CA
92312-0142
US

V. Phone/Fax

Practice location:
  • Phone: 760-256-7279
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number124285
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: