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General NPI Number Information
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NPI Number | 1114207511
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Entity Type | Individual
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Provider Name | WILLIAM M LEWIS LCDC
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Gender | Male
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Dates
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Enumeration Date | 08/17/2011
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Last Update Date | 08/17/2011
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Provider Practice Location Address
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Address Line | 845 HIGHWAY 96 S
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City | SILSBEE
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State | TX
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Zip | 77656-5809
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Country | US
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Telephone | 409-386-6772
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Fax |
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Provider Business Mailing Address
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Address Line | 32509 DECKER PRAIRIE RD #5
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City | PINEHURST
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State | TX
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Zip | 77362
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 10670
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License Number State | TX
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