MEDICARE: JIMMIE CHARLES 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	62415	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	62415	OTHER	TX	LICENSED PROFESSIONAL COUNSELOR

General Provider Information

NPI Number	:	1831356047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIMMIE CHARLES LEWIS L.P.C.

Provider Business Mailing Address
First Line	:	4200 MONTROSE BLVD
Second Line	:	SUITE 520
City	:	HOUSTON
State	:	TX
Zip	:	77006-5444
Country	:	US
Telephone Number	:	832-279-1958
Fax Number	:	713-522-8970

Provider Business Practice Location Address
First Line	:	4200 MONTROSE BLVD
Second Line	:	SUITE 520
City	:	HOUSTON
State	:	TX
Zip	:	77006-5444
Country	:	US
Telephone Number	:	832-279-1958
Fax Number	:	713-522-8970

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

Provider Enumeration Date	:	05/16/2008
Last Update Date	:	05/16/2008

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