Healthcare Provider Details

I. General information

NPI: 1013844505
Provider Name (Legal Business Name): MR. MATTHEW JOHN LEWIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 ADAMS AVE STE 214
COSTA MESA CA
92626-4865
US

IV. Provider business mailing address

18952 LISTER LN
HUNTINGTON BEACH CA
92646-1912
US

V. Phone/Fax

Practice location:
  • Phone: 714-957-1922
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number147500
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: