MEDICARE: ANESSA LEWIS LPC

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	101YM0800X	Mental Health Counselor	C6612	OR

General Provider Information

NPI Number	:	1255848909
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANESSA LEWIS LPC

Provider Business Mailing Address
First Line	:	222 SE 30TH PL
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97214-1917
Country	:	US
Telephone Number	:	916-832-2127
Fax Number	:	207-612-7686

Provider Business Practice Location Address
First Line	:	222 SE 30TH PL
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97214-1917
Country	:	US
Telephone Number	:	916-832-2127
Fax Number	:	207-612-7686

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

Provider Enumeration Date	:	01/03/2018
Last Update Date	:	07/27/2025

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