MEDICARE: MS. TWILA LYNETTE 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	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101Y00000X	Counselor		CA

General Provider Information

NPI Number	:	1144356197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TWILA LYNETTE LEWIS

Provider Business Mailing Address
First Line	:	2550 W CLINTON AVE BLDG W
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93705-4206
Country	:	US
Telephone Number	:	559-264-7521
Fax Number	:

Provider Business Practice Location Address
First Line	:	2550 W CLINTON AVE BLDG W
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93705-4206
Country	:	US
Telephone Number	:	559-264-7521
Fax Number	:

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

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	05/14/2021

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