Provider Demographics
NPI:1992270953
Name:LEWIS, THERESA LYVETTE (LMHC)
Entity type:Individual
Prefix:DR
First Name:THERESA
Middle Name:LYVETTE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4111 E HANNA AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33610-3817
Mailing Address - Country:US
Mailing Address - Phone:813-833-1215
Mailing Address - Fax:813-498-2714
Practice Address - Street 1:4111 E HANNA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610-3817
Practice Address - Country:US
Practice Address - Phone:813-833-1215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-05
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH19401101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty