=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194299107
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRISHA LEWIS LCSW LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/14/2019
-----------------------------------------------------
Last Update Date | 02/16/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 401 BOWLING AVE # UNTI76
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37205-2533
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-469-3914
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 401 BOWLING AVE UNIT 76
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37205-5142
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-469-3914
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANGER
-----------------------------------------------------
Name | MRS. TRISHA L LEWIS
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 608-469-3914
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------