Provider Demographics
NPI:1902308968
Name:LEWIS, COURTNEY RAE (LCSW)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:RAE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:RAE
Other - Last Name:THOMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:2919 VALMONT RD STE 104
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1350
Mailing Address - Country:US
Mailing Address - Phone:720-663-0163
Mailing Address - Fax:
Practice Address - Street 1:2919 VALMONT RD STE 104
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1350
Practice Address - Country:US
Practice Address - Phone:720-663-0163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-06
Last Update Date:2024-06-04
Deactivation Date:2022-05-19
Deactivation Code:
Reactivation Date:2022-07-07
Provider Licenses
StateLicense IDTaxonomies
COCSW.099302721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical