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General NPI Number Information
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NPI Number | 1689977084
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Entity Type | Individual
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Provider Name | CHARLA LEWIS PHD
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Gender | Female
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Dates
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Enumeration Date | 12/08/2010
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Last Update Date | 06/23/2021
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Provider Practice Location Address
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Address Line | 3025 E RENNER RD STE 303
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City | RICHARDSON
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State | TX
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Zip | 75082-3580
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Country | US
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Telephone | 713-457-4372
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Fax | 713-457-0945
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Provider Business Mailing Address
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Address Line | 6315 GULFTON ST STE 100
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City | HOUSTON
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State | TX
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Zip | 77081-1107
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Country | US
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Telephone | 713-457-4372
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Fax | 469-294-9175
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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 | 04586
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 1000544
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License Number State | DC
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 38413
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License Number State | TX
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