Healthcare Provider Details

I. General information

NPI: 1467375634
Provider Name (Legal Business Name): ROXANE LEWIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 INDIAN BOUNDARY RD
CHESTERTON IN
46304-1511
US

IV. Provider business mailing address

213 SPRING VIEW DR
PORTER IN
46304-8822
US

V. Phone/Fax

Practice location:
  • Phone: 219-250-5817
  • Fax:
Mailing address:
  • Phone: 219-250-5817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number88003378A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: