Provider Demographics
NPI:1366959405
Name:LEWIS, JODIE RAI (LPC, CRC, NCC)
Entity type:Individual
Prefix:
First Name:JODIE
Middle Name:RAI
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LPC, CRC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2499 NW 206TH AVE APT A233
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97006-6468
Mailing Address - Country:US
Mailing Address - Phone:208-946-6998
Mailing Address - Fax:
Practice Address - Street 1:2499 NW 206TH AVE APT A233
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97006-6468
Practice Address - Country:US
Practice Address - Phone:208-946-6998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-10
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-7008101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health