Provider Demographics
NPI:1538179320
Name:LEWIS, TRUDI SIEGLINDE (LCSW)
Entity type:Individual
Prefix:
First Name:TRUDI
Middle Name:SIEGLINDE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351
Mailing Address - Country:US
Mailing Address - Phone:606-783-1010
Mailing Address - Fax:606-783-1010
Practice Address - Street 1:129 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-1657
Practice Address - Country:US
Practice Address - Phone:606-783-1010
Practice Address - Fax:606-783-1010
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY21951041C0700X
KY30451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY30310026Medicaid
000000350189OtherANTHEM BCBS
WV1059550OtherWV WORKERS COMP
610661987006OtherTRICARE
610661987006OtherTRICARE