Provider Demographics
NPI:1730579558
Name:LEWIS, SHAWNA LEA (LPC)
Entity type:Individual
Prefix:MS
First Name:SHAWNA
Middle Name:LEA
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17103 PRESTON RD STE 288
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-1372
Mailing Address - Country:US
Mailing Address - Phone:972-439-5287
Mailing Address - Fax:
Practice Address - Street 1:17103 PRESTON RD STE 288
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-1372
Practice Address - Country:US
Practice Address - Phone:972-439-5287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-01
Last Update Date:2015-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70934101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health