Healthcare Provider Details

I. General information

NPI: 1720859291
Provider Name (Legal Business Name): TERRANCE LEWIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2024
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34921 US 19 N STE 450
PALM HARBOR FL
34684-1922
US

IV. Provider business mailing address

1279 PALMETTO ST
CLEARWATER FL
33755-4334
US

V. Phone/Fax

Practice location:
  • Phone: 305-527-8629
  • Fax:
Mailing address:
  • Phone: 305-527-8629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: