Provider Demographics
NPI:1528327814
Name:LEWIS, ANGELA JEANETTE (BHRS)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:JEANETTE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2921 LINDSAY LN
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:OK
Mailing Address - Zip Code:73084-3547
Mailing Address - Country:US
Mailing Address - Phone:405-549-8288
Mailing Address - Fax:
Practice Address - Street 1:2921 LINDSAY LN
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:OK
Practice Address - Zip Code:73084-3547
Practice Address - Country:US
Practice Address - Phone:405-549-8288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-08
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst