1851697601 NPI number — VETA LEWIS BEHAVIORAL HEALTHCARE GROUP, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851697601 NPI number — VETA LEWIS BEHAVIORAL HEALTHCARE GROUP, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VETA LEWIS BEHAVIORAL HEALTHCARE GROUP, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851697601
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1800 JUDSON RD
Provider Second Line Business Mailing Address:
100
Provider Business Mailing Address City Name:
LONGVIEW
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75605-4708
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-757-5200
Provider Business Mailing Address Fax Number:
903-757-5203

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1800 JUDSON RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
LONGVIEW
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75605-4708
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-757-5200
Provider Business Practice Location Address Fax Number:
903-757-5203
Provider Enumeration Date:
01/26/2011

Additional Information

Authorized Official

Authorized Official Last Name:
HODGE
Authorized Official First Name:
MARILYN
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
903-757-5200

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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