Provider Demographics
NPI:1316154768
Name:LEWIS, JONATHAN A (MHS, LPC, CAC, CCS)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:A
Last Name:LEWIS
Suffix:
Gender:M
Credentials:MHS, LPC, CAC, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 264
Mailing Address - Street 2:
Mailing Address - City:NORRISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19404-0264
Mailing Address - Country:US
Mailing Address - Phone:610-316-2887
Mailing Address - Fax:215-438-4159
Practice Address - Street 1:85 E SPRING AVE
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:PA
Practice Address - Zip Code:19003-2143
Practice Address - Country:US
Practice Address - Phone:610-316-2887
Practice Address - Fax:215-438-4159
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC000948101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1316154768Medicaid