Healthcare Provider Details

I. General information

NPI: 1164278677
Provider Name (Legal Business Name): ROBBY LEWIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2024
Last Update Date: 04/25/2024
Certification Date: 04/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 N FLORIDA ST
COVINGTON LA
70433-1557
US

IV. Provider business mailing address

1615 N FLORIDA ST
COVINGTON LA
70433-1557
US

V. Phone/Fax

Practice location:
  • Phone: 985-892-0869
  • Fax:
Mailing address:
  • Phone: 985-892-0869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8303
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: