Healthcare Provider Details

I. General information

NPI: 1528705068
Provider Name (Legal Business Name): ABBY LEWIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ABBY LEMASTER

II. Dates (important events)

Enumeration Date: 05/17/2022
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

767 MAIN ST
WEST LIBERTY KY
41472-1019
US

IV. Provider business mailing address

PO BOX 790
ASHLAND KY
41105-0790
US

V. Phone/Fax

Practice location:
  • Phone: 866-233-1955
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number306243
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: