Healthcare Provider Details

I. General information

NPI: 1346320207
Provider Name (Legal Business Name): LORENA LEWIS LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17121 SE 270TH PL SUITE 209
COVINGTON WA
98042-5431
US

IV. Provider business mailing address

17121 SE 270TH PL SUITE 209
COVINGTON WA
98042-5431
US

V. Phone/Fax

Practice location:
  • Phone: 206-406-6768
  • Fax: 253-631-3976
Mailing address:
  • Phone: 206-406-6768
  • Fax: 253-631-3976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLW00004261
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLW00004261
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW00004261
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: