Healthcare Provider Details

I. General information

NPI: 1184443228
Provider Name (Legal Business Name): CASEY LEWIS LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2024
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 E MISSISSIPPI AVE
RUSTON LA
71270-3905
US

IV. Provider business mailing address

1000 CHINABERRY DR STE 900
BOSSIER CITY LA
71111-2455
US

V. Phone/Fax

Practice location:
  • Phone: 318-202-3706
  • Fax: 318-202-3707
Mailing address:
  • Phone: 318-202-3706
  • Fax: 318-202-3707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number10405
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: