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NPI Code Detail

MEDICARE: LISA A HEWITT PH.D.

MEDICARE: LISA A HEWITT PH.D.
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
1103TC0700XClinical Psychologist35097TX

General Provider Information

NPI Number : 1881032779
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA A HEWITT PH.D.
Provider Business Mailing Address
First Line : 114 KEANAHALULULU LN
Second Line :
City : BASTROP
State : TX
Zip : 78602-6003
Country : US
Telephone Number : 817-917-3554
Fax Number :
Provider Business Practice Location Address
First Line : 909 PECAN ST
Second Line :
City : BASTROP
State : TX
Zip : 78602-3819
Country : US
Telephone Number : 512-321-7334
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2013
Last Update Date : 06/12/2013

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