Provider Demographics
NPI:1992205587
Name:LEWIS, THOMAS (LMHC)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:LEWIS
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:TOM
Other - Middle Name:
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7579 STARFISH REEF LN
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-6970
Mailing Address - Country:US
Mailing Address - Phone:561-906-1497
Mailing Address - Fax:
Practice Address - Street 1:150 E PALMETTO PARK RD STE 800
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-4833
Practice Address - Country:US
Practice Address - Phone:561-906-1497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8280101Y00000X, 101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)