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General NPI Number Information
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NPI Number | 1891222774
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Entity Type | Individual
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Provider Name | TIMOTHY PAUL LEWIS
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Gender | Male
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Dates
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Enumeration Date | 05/22/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 401 15TH AVE SE
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City | PUYALLUP
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State | WA
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Zip | 98372-3715
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Country | US
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Telephone | 253-686-8335
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Fax |
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Provider Business Mailing Address
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Address Line | 5414 MARIAN DR NE
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City | OLYMPIA
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State | WA
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Zip | 98516-2247
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Country | US
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Telephone | 253-686-8335
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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 | MHCAMC60323305
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License Number State | WA
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