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General NPI Number Information
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NPI Number | 1275846412
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Entity Type | Individual
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Provider Name | PATRICK JOSEPH LEWIS PSYD
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Gender | Male
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Dates
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Enumeration Date | 07/16/2010
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Last Update Date | 01/04/2018
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Provider Practice Location Address
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Address Line | 275 E SOUTH TEMPLE STE 150
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City | SALT LAKE CITY
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State | UT
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Zip | 84111-1270
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Country | US
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Telephone | 314-398-2351
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Fax | 801-853-8237
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Provider Business Mailing Address
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Address Line | 777 E SOUTH TEMPLE APT 8C
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City | SALT LAKE CITY
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State | UT
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Zip | 84102-1272
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Country | US
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Telephone | 314-398-2351
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Fax | 801-853-8237
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 9289374-2501
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License Number State | UT
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