Provider Demographics
NPI:1295944726
Name:LEWIS, GUY (PHD)
Entity type:Individual
Prefix:MR
First Name:GUY
Middle Name:
Last Name:LEWIS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8170 BEVERLY BLVD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-4524
Mailing Address - Country:US
Mailing Address - Phone:323-655-3489
Mailing Address - Fax:323-933-1591
Practice Address - Street 1:8170 BEVERLY BLVD
Practice Address - Street 2:SUITE 108
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-4524
Practice Address - Country:US
Practice Address - Phone:323-655-3489
Practice Address - Fax:323-933-1591
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14784103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist