Provider Demographics
NPI:1316458748
Name:LEWIS, ELLIOT JXAVIER (RAC)
Entity type:Individual
Prefix:MR
First Name:ELLIOT
Middle Name:JXAVIER
Last Name:LEWIS
Suffix:
Gender:M
Credentials:RAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 CROCKETT ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-3601
Mailing Address - Country:US
Mailing Address - Phone:318-226-2890
Mailing Address - Fax:
Practice Address - Street 1:2000 FAIRFIELD AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-2002
Practice Address - Country:US
Practice Address - Phone:318-226-2890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-12
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1438101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)