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General NPI Number Information
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NPI Number | 1013178904
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Entity Type | Organization
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Legal Business Name | CLINTON A. LEWIS, PSY.D., P.C.
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Dates
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Enumeration Date | 06/23/2008
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Last Update Date | 06/23/2008
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Provider Practice Location Address
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Address Line | 3855 S BOULEVARD ST STE 100
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City | EDMOND
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State | OK
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Zip | 73013-5499
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Country | US
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Telephone | 404-340-4321
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Fax |
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Provider Business Mailing Address
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Address Line | 3855 S BOULEVARD ST STE 100
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City | EDMOND
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State | OK
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Zip | 73013-5499
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Country | US
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Telephone | 404-340-4321
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CLINTON A LEWIS
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Credential | PSY.D.
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Telephone | 405-340-4321
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 896
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License Number State | OK
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