Healthcare Provider Details

I. General information

NPI: 1306933668
Provider Name (Legal Business Name): JAMES R. LEWIS PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 01/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1304 LORY ST
FORT COLLINS CO
80524-4214
US

IV. Provider business mailing address

1304 LORY ST
FORT COLLINS CO
80524-4214
US

V. Phone/Fax

Practice location:
  • Phone: 970-490-1801
  • Fax: 970-494-0481
Mailing address:
  • Phone: 970-490-1801
  • Fax: 970-494-0481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number856
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number394
License Number StateWY
# 3
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number394
License Number StateWY
# 4
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number856
License Number StateCO
# 5
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number394
License Number StateWY
# 6
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number856
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: