Healthcare Provider Details

I. General information

NPI: 1316700057
Provider Name (Legal Business Name): COURTNEY LEWIS THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2024
Last Update Date: 02/05/2024
Certification Date: 02/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1608 W COLONIAL PKWY STE 210
INVERNESS IL
60067-4755
US

IV. Provider business mailing address

1608 W COLONIAL PKWY STE 210
INVERNESS IL
60067-4755
US

V. Phone/Fax

Practice location:
  • Phone: 847-780-7262
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: COURTNEY LEWIS
Title or Position: THERAPIST
Credential: LCSW
Phone: 847-780-7262