Provider Demographics
NPI:1598776965
Name:LEWIS, JOHN GILBERT (LAC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:GILBERT
Last Name:LEWIS
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 219
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59103-0219
Mailing Address - Country:US
Mailing Address - Phone:406-252-5658
Mailing Address - Fax:406-238-3617
Practice Address - Street 1:1245 NORTH 29TH STREET
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101
Practice Address - Country:US
Practice Address - Phone:406-252-5658
Practice Address - Fax:406-238-3617
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT535CDC101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)