Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TC1900X | Counseling Psychologist | 215 | TN |
NPI | 1053345645 |
---|---|
Provider Name | Dr. Kent E Lewis |
First Address | Tullahoma, TN 37388 |
Second Address | Tullahoma, TN 37388 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 08/07/2007 |