Provider Demographics
NPI:1316304496
Name:LEWIS, DENISE DARLENE
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:DARLENE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3335 HAUCK ST APT 2043
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-8024
Mailing Address - Country:US
Mailing Address - Phone:702-300-1473
Mailing Address - Fax:
Practice Address - Street 1:3335 HAUCK ST APT 2043
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-8024
Practice Address - Country:US
Practice Address - Phone:702-300-1473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-21
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health