1679161228 NPI number — KYLE AUSTIN LEWIS MA, LPC

Table of content: KYLE AUSTIN LEWIS MA, LPC (NPI 1679161228)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679161228 NPI number — KYLE AUSTIN LEWIS MA, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEWIS
Provider First Name:
KYLE
Provider Middle Name:
AUSTIN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, LPC
Provider Gender Code:
M

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:
1679161228
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/22/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
910 DANIELS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TORONTO
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43964-1318
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-424-8934
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
320 MARKET ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STEUBENVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43952-2153
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-314-5339
Provider Business Practice Location Address Fax Number:
740-314-5527
Provider Enumeration Date:
01/08/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

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)