Provider Demographics
NPI:1174752869
Name:LEWIS, PATRICIA E (MH REHAB SPEC)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:E
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MH REHAB SPEC
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:E
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5805 GOLD DUST DR
Mailing Address - Street 2:
Mailing Address - City:KELSEYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95451-9205
Mailing Address - Country:US
Mailing Address - Phone:707-278-0158
Mailing Address - Fax:
Practice Address - Street 1:237 E GOBBI ST
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-5551
Practice Address - Country:US
Practice Address - Phone:707-472-2922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-02
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor