Provider Demographics
NPI:1851829402
Name:LEWIS, JASON LEE (MA, MBC, LMFT, MPA)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:LEE
Last Name:LEWIS
Suffix:
Gender:M
Credentials:MA, MBC, LMFT, MPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2496 WILDCAT RD
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:TN
Mailing Address - Zip Code:38583-6588
Mailing Address - Country:US
Mailing Address - Phone:931-252-3786
Mailing Address - Fax:
Practice Address - Street 1:17 E MAPLE ST
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:TN
Practice Address - Zip Code:38583-2270
Practice Address - Country:US
Practice Address - Phone:931-252-3786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-26
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2016106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist