Healthcare Provider Details

I. General information

NPI: 1053650887
Provider Name (Legal Business Name): GERALD LEWIS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2013
Last Update Date: 05/19/2024
Certification Date: 05/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 MURVIHILL RD
VALPARAISO IN
46383-5960
US

IV. Provider business mailing address

9120 CONNECTICUT ST STE A
MERRILLVILLE IN
46410-7015
US

V. Phone/Fax

Practice location:
  • Phone: 219-286-3907
  • Fax: 219-286-3911
Mailing address:
  • Phone: 219-793-1233
  • Fax: 219-793-1244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number70000167A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. GERALD C. LEWIS
Title or Position: OWNER
Credential: CNS
Phone: 219-743-3907