Provider Demographics
NPI:1700520715
Name:LEWIS, ELIZABETH (LPC-S)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5112 COLLINWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-3608
Mailing Address - Country:US
Mailing Address - Phone:682-308-4038
Mailing Address - Fax:
Practice Address - Street 1:1814 8TH AVE # 101-103B
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76110-1354
Practice Address - Country:US
Practice Address - Phone:817-781-3735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-25
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64678101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health