Healthcare Provider Details

I. General information

NPI: 1952500712
Provider Name (Legal Business Name): PAUL RANDALL LEWIS PAUL LEWIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: PAUL LEWIS PAUL LEWIS LMFT

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 EADS LN
LOPEZ ISLAND WA
98261-7717
US

IV. Provider business mailing address

PO BOX 534
LOPEZ ISLAND WA
98261-0534
US

V. Phone/Fax

Practice location:
  • Phone: 360-472-0028
  • Fax:
Mailing address:
  • Phone: 360-472-0028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLF60233335
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: