Provider Demographics
NPI:1316957624
Name:LEWIS, CLINTON ALLEN (PSYD)
Entity type:Individual
Prefix:
First Name:CLINTON
Middle Name:ALLEN
Last Name:LEWIS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 W MEMORIAL RD STE 218
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-6103
Mailing Address - Country:US
Mailing Address - Phone:405-286-2977
Mailing Address - Fax:
Practice Address - Street 1:3000 W MEMORIAL RD STE 218
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-6103
Practice Address - Country:US
Practice Address - Phone:405-286-2977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2025-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK896103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist