Provider Demographics
NPI:1851069751
Name:LEWIS, CHARLEEN J (CCPC)
Entity type:Individual
Prefix:MS
First Name:CHARLEEN
Middle Name:J
Last Name:LEWIS
Suffix:
Gender:F
Credentials:CCPC
Other - Prefix:
Other - First Name:CJ
Other - Middle Name:
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CCPC
Mailing Address - Street 1:16000 CHRISTENSEN RD STE 200
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98188-2925
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16000 CHRISTENSEN RD STE 200
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-2925
Practice Address - Country:US
Practice Address - Phone:702-589-4872
Practice Address - Fax:702-589-4871
Is Sole Proprietor?:No
Enumeration Date:2021-09-03
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X, 101YM0800X
WA172V00000X
WACG61238184175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No172V00000XOther Service ProvidersCommunity Health Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health