Provider Demographics
NPI:1427285352
Name:LEWIS, MAUREEN LYNELL
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:LYNELL
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 1:18551 E MAINSTREET STE 1B
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-4951
Mailing Address - Country:US
Mailing Address - Phone:303-805-1902
Mailing Address - Fax:303-805-2019
Practice Address - Street 1:18551 E MAINSTREET STE 1B
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-4951
Practice Address - Country:US
Practice Address - Phone:303-805-1902
Practice Address - Fax:303-805-2019
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CO9719225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health