MEDICARE: MR. DOUGLAS W LEWIS L.P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	19781	TX

General Provider Information

NPI Number	:	1043484785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DOUGLAS W LEWIS L.P.C.

Provider Business Mailing Address
First Line	:	5210 NEWCOME DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-4927
Country	:	US
Telephone Number	:	210-748-8367
Fax Number	:	210-680-4947

Provider Business Practice Location Address
First Line	:	1716 S SAN MARCOS
Second Line	:	ROOM 203
City	:	SAN ANTONIO
State	:	TX
Zip	:	78207-7094
Country	:	US
Telephone Number	:	210-748-5879
Fax Number	:	210-680-4947

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2008
Last Update Date	:	04/14/2008

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