Provider Demographics
NPI:1598572257
Name:LEWALLEN, EMMA MOSS (MED)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:MOSS
Last Name:LEWALLEN
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:EMMA
Other - Middle Name:
Other - Last Name:IERLEY-MOSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6252 URBAN CT
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80004-4028
Mailing Address - Country:US
Mailing Address - Phone:303-217-0885
Mailing Address - Fax:
Practice Address - Street 1:3900 S WADSWORTH BLVD STE 435
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80235-2207
Practice Address - Country:US
Practice Address - Phone:303-551-9214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist