Provider Demographics
NPI:1265304133
Name:LEWIS, TYRONE A (QMHS 3)
Entity type:Individual
Prefix:
First Name:TYRONE
Middle Name:A
Last Name:LEWIS
Suffix:
Gender:M
Credentials:QMHS 3
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5553 CHATFORD DR APT A
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-3081
Mailing Address - Country:US
Mailing Address - Phone:614-359-6538
Mailing Address - Fax:
Practice Address - Street 1:5553 CHATFORD DR APT A
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-3081
Practice Address - Country:US
Practice Address - Phone:614-359-6538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-20
Last Update Date:2025-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management