MEDICARE: MR. STEVON JAMAL LEWIS

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	106H00000X	Marriage & Family Therapist	52608	CA

General Provider Information

NPI Number	:	1124218615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STEVON JAMAL LEWIS

Provider Business Mailing Address
First Line	:	PO BOX 140
Second Line	:
City	:	HERMOSA BEACH
State	:	CA
Zip	:	90254-0140
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2447 PACIFIC COAST HWY STE 200
Second Line	:
City	:	HERMOSA BEACH
State	:	CA
Zip	:	90254-2714
Country	:	US
Telephone Number	:	310-597-7580
Fax Number	:

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

Provider Enumeration Date	:	07/31/2007
Last Update Date	:	04/11/2021

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