Provider Demographics
NPI:1548540040
Name:LEWIS-WEIR, BRISHEN MARIE
Entity type:Individual
Prefix:MS
First Name:BRISHEN
Middle Name:MARIE
Last Name:LEWIS-WEIR
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 1:14074 TRADE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-4563
Mailing Address - Country:US
Mailing Address - Phone:317-459-0676
Mailing Address - Fax:
Practice Address - Street 1:14074 TRADE CENTER DR
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-4563
Practice Address - Country:US
Practice Address - Phone:317-824-9237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-29
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99048072A101YS0200X
IN34006593A101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool