Provider Demographics
NPI:1093869703
Name:LEWIS, TERRY GAIL (LMFT)
Entity type:Individual
Prefix:MS
First Name:TERRY
Middle Name:GAIL
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MRS
Other - First Name:TERRY
Other - Middle Name:GAIL
Other - Last Name:LEWIS-NWACHIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFTI
Mailing Address - Street 1:1909 N NIAGARA ST
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-1226
Mailing Address - Country:US
Mailing Address - Phone:818-425-8021
Mailing Address - Fax:213-788-2120
Practice Address - Street 1:1909 N NIAGARA ST
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-1226
Practice Address - Country:US
Practice Address - Phone:818-425-8021
Practice Address - Fax:213-788-2120
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA143948106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist