Healthcare Provider Details

I. General information

NPI: 1801924618
Provider Name (Legal Business Name): JACLYN LEWINSKI PHD, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 E 5TH AVE APT 129
EUGENE OR
97401-0015
US

IV. Provider business mailing address

355 E 5TH AVE APT 129
EUGENE OR
97401-0015
US

V. Phone/Fax

Practice location:
  • Phone: 629-777-6007
  • Fax: 615-679-3900
Mailing address:
  • Phone: 629-777-6007
  • Fax: 615-679-3900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401009499
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2478
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401009499
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC8677
License Number StateOR
# 5
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC8677
License Number StateOR
# 6
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2478
License Number StateTN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: