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410 County Road 3640 Sulphur Springs TX 75482-6913 | |
| (903) 885-2273 | |
| (469) 375-5375 |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 410 County Road 3640, Sulphur Springs, Texas |
| Authorized Official Name and Position | David Israel Lewis (PRESIDENT) |
| Authorized Official Contact | 9033481932 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
111 Jill Ln Sulphur Springs TX 75482-3513 Ph: (903) 348-1932 | 410 County Road 3640 Sulphur Springs TX 75482-6913 Ph: (903) 885-2273 |
| NPI Number | 1447501127 |
|---|---|
| Provider Enumeration Date | 09/21/2012 |
| Last Update Date | 09/24/2024 |
| Certification Date | 09/24/2024 |
| Medicare PECOS PAC ID | 8527406248 |
|---|---|
| Medicare Enrollment ID | O20240401001619 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447501127 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 19719 (Texas) | Primary |
| 106H00000X | Marriage & Family Therapist | 4923 (Texas) | Secondary |
| Provider Name | David Israel Lewis |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1255499471 PECOS PAC ID: 9436597150 Enrollment ID: I20240401001743 |
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