Provider Demographics
NPI:1053345645
Name:LEWIS, KENT E (D MIN)
Entity type:Individual
Prefix:DR
First Name:KENT
Middle Name:E
Last Name:LEWIS
Suffix:
Gender:M
Credentials:D MIN
Other - Prefix:DR
Other - First Name:KENT
Other - Middle Name:E
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS D MIN
Mailing Address - Street 1:PO BOX 1296
Mailing Address - Street 2:
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388
Mailing Address - Country:US
Mailing Address - Phone:931-455-8504
Mailing Address - Fax:931-393-2996
Practice Address - Street 1:612 WILSON AVE
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388
Practice Address - Country:US
Practice Address - Phone:931-455-8504
Practice Address - Fax:931-393-2996
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN215103TC1900X
TN220106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist