Provider Demographics
NPI:1902078793
Name:LEWIS, URSULA
Entity Type:Individual
Prefix:
First Name:URSULA
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7958 CARMENCITA AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95829-9444
Mailing Address - Country:US
Mailing Address - Phone:253-228-7801
Mailing Address - Fax:
Practice Address - Street 1:5170 GOLDEN FOOTHILL PKWY # 150
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-9608
Practice Address - Country:US
Practice Address - Phone:253-228-7801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-01
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist