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General NPI Number Information
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NPI Number | 1700520715
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Entity Type | Individual
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Provider Name | ELIZABETH LEWIS LPC-S
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Gender | Female
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Dates
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Enumeration Date | 04/25/2022
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Last Update Date | 04/25/2022
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Provider Practice Location Address
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Address Line | 1814 8TH AVE # 101-103B
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City | FORT WORTH
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State | TX
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Zip | 76110-1354
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Country | US
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Telephone | 817-781-3735
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Fax |
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Provider Business Mailing Address
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Address Line | 5112 COLLINWOOD AVE
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City | FORT WORTH
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State | TX
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Zip | 76107-3608
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Country | US
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Telephone | 682-308-4038
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 64678
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License Number State | TX
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