Healthcare Provider Details

I. General information

NPI: 1275041774
Provider Name (Legal Business Name): ALEXIS ROSE LEWIS MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2018
Last Update Date: 04/15/2020
Certification Date: 04/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2455 SUTHERLAND AVE
KNOXVILLE TN
37919-2355
US

IV. Provider business mailing address

201 W SPRINGDALE AVE
KNOXVILLE TN
37917-5158
US

V. Phone/Fax

Practice location:
  • Phone: 865-558-9040
  • Fax:
Mailing address:
  • Phone: 865-637-9711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4994
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: