Provider Demographics
NPI:1891362943
Name:LEWIS, JESSICA STYLES (PHD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:STYLES
Last Name:LEWIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11103 CAPE PRIMROSE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78245-3713
Mailing Address - Country:US
Mailing Address - Phone:864-616-8108
Mailing Address - Fax:
Practice Address - Street 1:4242 MEDICAL DR STE 6300
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-5372
Practice Address - Country:US
Practice Address - Phone:844-824-8775
Practice Address - Fax:281-648-2200
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
TX39837103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist